Regenerize Psychiatry PLLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

REGENERIZE PSYCHIATRY PLLC

Practice address

605 S Olive Ave
Sandpoint, ID 83864-1154

Phone

(209) 677-7747

NPI assigned

Jun 24, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Radley Peterson

Title

Owner

Phone

(208) 899-5997

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Cheryl Cleveland, APRN

  • Psychiatric/Mental Health Nurse Practitioner
  • Lexington, KY
  • NPI 1144070236

  ID

  Medicare reassignment NPD
• Michelle Monson, APRN

  • Psychiatric/Mental Health Nurse Practitioner
  • Dallas, TX
  • NPI 1861110629

  ID

  Medicare reassignment NPD
• Rio Peterson, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • New Meadows, ID
  • NPI 1841966819
  NPD
• Tawni Peterson

  • Primary Care Nurse Practitioner
  • Council, ID
  • NPI 1508226226
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1719187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729987200000",
    "number": "1043054075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 S OLIVE AVE",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838641154",
            "telephone_number": "208-606-0620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 S OLIVE AVE",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838641154",
            "telephone_number": "209-677-7747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGENERIZE PSYCHIATRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-24",
        "last_updated": "2024-10-27",
        "certification_date": "2024-10-27",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "RADLEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-899-5997"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alicia Reed, LMT
• Melinda Jane Reed, OT
• Gerald Lee Reeser, CDP
• Stephanie Shawn Reeves, LCPC
• Reflections Counseling and Life Coaching LLC
• Lorraine Ann Reigel, SLP
• Tessa Marie Reinke, MD
• Renew Counseling & Psychotherapy, PLLC
• Carl T. Renfro III, PH.D.
• Daryl W. Reoch, D.C.

• Mental Health Clinic/Center (Including Community Mental Health Center) in Sandpoint, ID
• Providers in Sandpoint, ID by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.