NPIMap

Organization Active NPI

Shukrana LLC

Doing business as Ellie Mental Health

  • Marriage & Family Therapist
  • Ponte Vedra, FL
National Provider Identifier
1053018143
Registry record updated Jun 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
Legal business name
SHUKRANA LLC
Doing business as
Ellie Mental Health
Ellie Mental Health Ponte Vedra
Practice address
1102 A1A N Ste 203
Ponte Vedra, FL 32082-4098
Phone
(904) 903-6375
NPI assigned
Feb 9, 2023
Last updated
Jun 1, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2023

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

Authorized official

Name
Ansh Grover
Title
Coo
Phone
(904) 903-6375

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X NU Primary

Addresses

Primary practice location

1102 A1A N Ste 203
Ponte Vedra, FL 32082-4098

Mailing address

1102 A1A N Ste 203
Ponte Vedra Beach, FL 32082-4098
Phone (904) 903-6375

Other names 2

  • Ellie Mental Health Doing business as
  • Ellie Mental Health Ponte Vedra Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230615001821 FL Part B Supplier - Clinic/Group Practice 7618335159 Receives reassigned benefits from 6 practitioners
Practice locations: Ponte Vedra, FL

National Provider Directory

National Provider Directory

Locations

1102 A1A N
Ste 203
Ponte Vedra Beach, FL 32082
Phone (904) 569-6875

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1675900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685577600000",
    "number": "1053018143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1102 A1A N STE 203",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320824098",
            "telephone_number": "904-903-6375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 A1A N STE 203",
            "city": "PONTE VEDRA",
            "state": "FL",
            "postal_code": "320824098",
            "telephone_number": "904-903-6375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHUKRANA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-09",
        "last_updated": "2023-06-01",
        "certification_date": "2023-06-01",
        "status": "A",
        "authorized_official_last_name": "GROVER",
        "authorized_official_first_name": "ANSH",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "904-903-6375"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ellie Mental Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ellie Mental Health Ponte Vedra",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ellie Mental Health Ponte Vedra",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ponte Vedra, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2023; 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.