Angela South

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

0034233 Issued in OH

Practice address

3567 Reserve Commons Dr Ste 100
Medina, OH 44256-5344

Phone

(330) 664-9250

NPI assigned

Mar 20, 2023

Last updated

Jun 26, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OH, CO, AK3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 3

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Alcove Ventures LLCGroup PAC ID 1456669605, 50 clinicians

Woodstream WellnessGroup PAC ID 8527462506, 55 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Caribou Medical Center Hospital, Soda Springs, ID, CCN 131309

Merit-based Incentive Payment System (MIPS)

Final score

98.06 of 100Reported as group

Quality

90.22

Promoting interoperability

100

Improvement activities

40

Cost

69.97

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-usa.unify.chbase.com/org/cordova-527880fe

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Alcove Ventures LLC

  dba Psych360

  • Psychiatric/Mental Health Nurse Practitioner
  • Cleveland, OH
  • NPI 1093191322
  Medicare reassignment Care Compare group NPD
• Woodstream Wellness

  • Psychiatric/Mental Health Nurse Practitioner
  • Miamisburg, OH
  • NPI 1265001234
  Medicare reassignment Care Compare group NPD
• Cordova Community Medical Center

  • Critical Access Hospital
  • Cordova, AK
  • NPI 1215035787
  Medicare reassignment NPD
• Mindcare Solutions PC

  • Psychiatry Physician
  • Nashville, TN
  • NPI 1457015091

  CO

  Medicare reassignment NPD
• WS Wellness LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Miamisburg, OH
  • NPI 1225710668
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Caribou Medical Center, Inc

  dba Caribou Medical Center

  • Critical Access Hospital
  • Soda Springs, ID
  • NPI 1942970272
  Care Compare affiliation

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

{
    "created_epoch": "1679270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687737600000",
    "number": "1114629540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3567 RESERVE COMMONS DR STE 100",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442565344",
            "telephone_number": "330-664-9250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3567 RESERVE COMMONS DR STE 100",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442565344",
            "telephone_number": "330-664-9250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUTH",
        "first_name": "ANGELA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-20",
        "last_updated": "2023-06-26",
        "certification_date": "2023-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OH",
            "license": "0034233",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "398808",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cynthia Kay Sorensen
• Kaleena Sorma, R.N.
• Soul's Journey Counseling, LLC (Beverly Major)
• South Court Dental Medicine, Inc. -Jeffrey C Esterburg D.M.D. and Mich
• South Court Family Physicians Inc
• Taylor Sowell
• B. Christopher Space, DDS
• Carol Jean Spartano
• Mark C Speelman, MD
• Bonnie Marie Spinder

• Psychiatric/Mental Health Nurse Practitioner in Medina, OH
• Providers in Medina, OH by specialty
• Psychiatric/Mental Health Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.