Active NPI
Radical Elevation
- Community/Behavioral Health Agency
- Las Vegas, NV
National Provider Identifier
1164097556
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Behavioral Health Agency
- Legal business name
- RADICAL ELEVATION
- Practice address
- 3551 E Bonanza Rd Ste 101
Las Vegas, NV 89110-2198 - Phone
- (702) 482-7441
- NPI assigned
- May 26, 2021
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Brian Harge, CVA
- Title
- Owner
- Phone
- (702) 423-2703
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | Primary |
Addresses
Primary practice location
3551 E Bonanza Rd Ste 101
Las Vegas, NV 89110-2198
Mailing address
3551 E Bonanza Rd Ste 101
Las Vegas, NV 89110-2198
Phone (702) 482-7441
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NV
Enrollment records 1
National Provider Directory
National Provider Directory- Tax ID family
- Radical Elevation
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Case Management Agency
- Houston, TX
- NPI 1134078744
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Clinical Social Worker
- Las Vegas, NV
- NPI 1417200767
-
- Clinical Social Worker
- Las Vegas, NV
- NPI 1497064935
-
- Social Worker
- Las Vegas, NV
- NPI 1629456249
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1621987200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1727049600000",
"number": "1164097556",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3551 E BONANZA RD STE 101",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891102198",
"telephone_number": "702-482-7441"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3551 E BONANZA RD STE 101",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891102198",
"telephone_number": "702-482-7441"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "RADICAL ELEVATION",
"organizational_subpart": "NO",
"enumeration_date": "2021-05-26",
"last_updated": "2024-09-23",
"certification_date": "2024-09-23",
"status": "A",
"authorized_official_last_name": "HARGE",
"authorized_official_first_name": "BRIAN",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "702-423-2703",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "CVA"
},
"taxonomies": [
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 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.