Elite Psychiatry Specialist

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

ELITE PSYCHIATRY SPECIALIST

Practice address

88 Lochnagar Mountain Dr
Saint Johns, FL 32259-6672

Phone

(812) 870-8683

NPI assigned

Aug 3, 2022

Organization subpart

No

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

Authorized official

Name

Mr. Brian Clukie

Title

Administrator

Phone

(813) 997-2099

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 2

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

• Lauren Anderson, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Ponte Vedra, FL
  • NPI 1528825049
  Medicare reassignment Care Compare group NPD
• Soufyane Bourass

  • Psychiatric/Mental Health Nurse Practitioner
  • Saint Augustine, FL
  • NPI 1306590633
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1659484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698105600000",
    "number": "1326775016",
    "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": "88 LOCHNAGAR MOUNTAIN DR",
            "city": "SAINT JOHNS",
            "state": "FL",
            "postal_code": "322596672",
            "telephone_number": "812-870-8683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE PSYCHIATRY SPECIALIST",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-03",
        "last_updated": "2023-10-24",
        "certification_date": "2023-10-24",
        "status": "A",
        "authorized_official_last_name": "CLUKIE",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "813-997-2099",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "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": "Elite Psychiatry Specialist",
            "address_1": "88 Lochnagar Mountain Dr",
            "city": "Saint Johns",
            "state": "FL",
            "country_code": "US",
            "postal_code": "322596672",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Saint Johns, FL
• Providers in Saint Johns, 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 Oct 24, 2023; 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.