Organization Active NPI

Ultimate Psychiatry PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Mesa, AZ
National Provider Identifier
1083462378
Registry record updated May 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
ULTIMATE PSYCHIATRY PLLC
Practice address
1155 S Power Rd Ste 114
Mesa, AZ 85206-3716
Phone
(832) 819-4378
Fax
(253) 954-3116
NPI assigned
May 10, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2024

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

Authorized official

Name
Annabel OwusuNPI 1588975452
Title
Owner
Phone
(832) 819-4378

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

1155 S Power Rd Ste 114
Mesa, AZ 85206-3716

Mailing address

4257 S Soboba St
Gilbert, AZ 85297-8263
Phone (832) 819-4378

Other names 1

  • Ultimate Psychiatry PLLC Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240724002115 AZ Part B Supplier - Clinic/Group Practice 9234675448 Receives reassigned benefits from 2 practitioners
Practice locations: Gilbert, AZ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1715299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715299200000",
    "number": "1083462378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4257 S SOBOBA ST",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852978263",
            "telephone_number": "832-819-4378",
            "fax_number": "253-954-3116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1155 S POWER RD STE 114",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852063716",
            "telephone_number": "832-819-4378",
            "fax_number": "253-954-3116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ULTIMATE PSYCHIATRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-10",
        "last_updated": "2024-05-10",
        "certification_date": "2024-05-02",
        "status": "A",
        "authorized_official_last_name": "OWUSU",
        "authorized_official_first_name": "ANNABEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "832-819-4378"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ultimate Psychiatry PLLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 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.