Individual provider Active NPI

Sofia Elena Verdeja Mitchell, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Brockton, MA
National Provider Identifier
1184297210
Registry record updated Jan 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
RN2301037 Issued in MA
Practice address
231 Main St
Brockton, MA 02301-4342
Phone
(508) 586-2660
NPI assigned
Jul 16, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Registered Nurse 163WP0808X RN2301037 MA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X RN2301037 MA Primary

Addresses

Primary practice location

231 Main St
Brockton, MA 02301-4342

Mailing address

3569 Fairway Forest Dr
Palm Harbor, FL 34685-1003
Phone (781) 242-5586

Other practice location 1

3569 Fairway Forest Dr
Palm Harbor, FL 34685-1003
Phone (781) 242-5586

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20230106001240 MA Practitioner - Nurse Practitioner 6901276013 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Northeast Health Services LLCGroup PAC ID 6901866706, 470 clinicians

Practice addresses (Care Compare)

231 Main St
FL 3
Brockton, MA 02301-4342
Phone (508) 586-2660

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN2301037MAMDPsychiatric/Mental Health Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Health Services, LLC CurrentSince Sep 8, 2022 Accepting new patients
Northeast Health Services Past Accepting new patients

Locations

231 Main St
Fl 3
Brockton, MA 02301
Phone (508) 586-2660

30 Taunton Grn
Ste 5
Taunton, MA 02780
Phone (508) 545-7400

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1626393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705536000000",
    "number": "1184297210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3569 FAIRWAY FOREST DR",
            "city": "PALM HARBOR",
            "state": "FL",
            "postal_code": "346851003",
            "telephone_number": "781-242-5586",
            "fax_number": "781-205-1566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "231 MAIN ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023014342",
            "telephone_number": "508-586-2660"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3569 Fairway Forest Dr",
            "address_purpose": "LOCATION",
            "city": "Palm Harbor",
            "state": "FL",
            "postal_code": "346851003",
            "country_code": "US",
            "telephone_number": "781-242-5586",
            "fax_number": "781-205-1566",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VERDEJA MITCHELL",
        "first_name": "SOFIA",
        "middle_name": "ELENA",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-16",
        "last_updated": "2024-01-18",
        "certification_date": "2024-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "MA",
            "license": "RN2301037",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MA",
            "license": "RN2301037",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brockton, MA

Sources for this page

Verify at the official NPI Registry.