Soufyane Bourass

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

APRN11017959 Issued in FL

Practice address

1400 Old Dixie Hwy
Saint Augustine, FL 32084-4190

Phone

(904) 824-0724

NPI assigned

Feb 6, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

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

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Elite Psychiatry SpecialistGroup PAC ID 5193197002, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: soufyanebourass.elitepsychiatryspecialist@161780.advancedmd-direct.com

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.

• Elite Psychiatry Specialist

  • Psychiatric/Mental Health Nurse Practitioner
  • Saint Johns, FL
  • NPI 1326775016
  Medicare reassignment Care Compare group NPD
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  Psychiatric/Mental Health

  Medicare reassignment NPD
• Epic Community Services, Inc

  • Community/Behavioral Health Agency
  • St Augustine, FL
  • NPI 1831279280
  NPD (past)

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

{
    "created_epoch": "1644105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659484800000",
    "number": "1306590633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "88 LOCHNAGAR MOUNTAIN DR",
            "city": "SAINT JOHNS",
            "state": "FL",
            "postal_code": "322596672",
            "telephone_number": "812-870-8683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 OLD DIXIE HWY",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320844190",
            "telephone_number": "904-824-0724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURASS",
        "first_name": "SOUFYANE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-02-06",
        "last_updated": "2022-08-03",
        "certification_date": "2022-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "APRN11017959",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sbourass@epicbh.org",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "EPIC",
            "address_1": "1400 Old Dixie Hwy",
            "city": "Saint Augustine",
            "state": "FL",
            "country_code": "US",
            "postal_code": "320844190",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jack Bosma, PT, DPT, CSCS
• Cody Bryan Boswell, DC
• Hugo Botero, DPT
• Leiane Moore Boudreau, ARNP
• Luis J Boulier, COTA
• Richard Bourdon Escoda, PSY.D.
• Terri Bowling, OT
• Justin Scott Bowman, FNP-BC
• Kristin Bowman
• Zelia Ramone Karema Bowman, MD

• Psychiatric/Mental Health Nurse Practitioner in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2022; 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.