NPIMap

Organization Active NPI

Thrive Behavioral Sciences Orlando LLC

  • Geriatric Psychiatry Physician
  • Orlando, FL
National Provider Identifier
1063979730
Registry record updated Aug 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Psychiatry PhysicianTaxonomy code 2084P0805X
Legal business name
THRIVE BEHAVIORAL SCIENCES ORLANDO LLC
Practice address
4700 Millenia Blvd Ste 500
Orlando, FL 32839-6019
Phone
(813) 467-6111
NPI assigned
Feb 28, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2024

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

Authorized official

Name
Jolene De la Gardelle
Title
VP Operations
Phone
(813) 277-4571

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0805X Primary

Addresses

Primary practice location

4700 Millenia Blvd Ste 500
Orlando, FL 32839-6019

Mailing address

5510 N Hesperides St
Tampa, FL 33614-5414
Phone (813) 277-4571

Other practice location 1

7512 Dr Phillips Blvd Ste 50-209
Orlando, FL 32819-5420
Phone (813) 467-6111

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address lomonico@thrivebehavioralsciences.com

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190402002627 FL Part B Supplier - Clinic/Group Practice 9739420654 Receives reassigned benefits from 48 practitioners
Practice locations: Orlando, FL

National Provider Directory

National Provider Directory

Locations

7512 Dr Phillips Blvd
Ste 50-209
Orlando, FL 32819
Phone (813) 467-6111

Networks

  • HealthSun Health Plans Network

Practitioners & affiliated clinicians

Practitioners 48

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

View all 48

NPI Registry JSON

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

{
    "created_epoch": "1551312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723766400000",
    "number": "1063979730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5510 N HESPERIDES ST",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336145414",
            "telephone_number": "813-277-4571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 MILLENIA BLVD STE 500",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328396019",
            "telephone_number": "813-467-6111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7512 Dr Phillips Blvd Ste 50-209",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328195420",
            "country_code": "US",
            "telephone_number": "813-467-6111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "THRIVE BEHAVIORAL SCIENCES ORLANDO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-28",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A",
        "authorized_official_last_name": "DE LA GARDELLE",
        "authorized_official_first_name": "JOLENE",
        "authorized_official_title_or_position": "VP OPERATIONS",
        "authorized_official_telephone_number": "813-277-4571"
    },
    "taxonomies": [
        {
            "code": "2084P0805X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lomonico@thrivebehavioralsciences.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "address_1": "7512 Dr Phillips Blvd Ste 50-209",
            "city": "Orlando",
            "state": "FL",
            "country_code": "US",
            "postal_code": "328195420",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 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.