South Mountain Family Psychiatry, LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

SOUTH MOUNTAIN FAMILY PSYCHIATRY, LLC

Practice address

11022 S 51St St Ste 250
Phoenix, AZ 85044-4308

Phone

(480) 939-6137

Fax

(602) 429-8445

NPI assigned

Jan 1, 2020

Organization subpart

No

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

Authorized official

Name

Mr. John W Wilson Jr.

Title

Business Manager

Phone

(602) 418-9105

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/21710/brand/1/csg/1/fhir/r4

Practitioners 6

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

• Jennifer Lindsey Atwood Green, RN, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Phoenix, AZ
  • NPI 1013458629
  Medicare reassignment Care Compare group NPD
• Carmen Lervold, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Phoenix, AZ
  • NPI 1972238731
  Medicare reassignment Care Compare group NPD
• Elizabeth Burnett Rogers, PMH-NP, CNS

  • Psychiatric/Mental Health Nurse Practitioner
  • Phoenix, AZ
  • NPI 1912910472
  Medicare reassignment Care Compare group NPD
• Joo Nam Tatham, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Phoenix, AZ
  • NPI 1982286191
  Medicare reassignment Care Compare group NPD
• Marlene Elizabeth Wilson, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Phoenix, AZ
  • NPI 1205175304
  Medicare reassignment Care Compare group NPD
• Kayla Marie Kelsen, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Phoenix, AZ
  • NPI 1679434773
  NPD

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

{
    "created_epoch": "1577836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624233600000",
    "number": "1336788868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11022 S 51ST ST STE 250",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850444308",
            "telephone_number": "480-939-6137",
            "fax_number": "602-429-8445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11022 S 51ST ST STE 250",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850444308",
            "telephone_number": "480-939-6137",
            "fax_number": "602-429-8445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH MOUNTAIN FAMILY PSYCHIATRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-01",
        "last_updated": "2021-06-21",
        "certification_date": "2021-06-21",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "602-418-9105",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• South Central Dental LLC
• South Mountain Anesthesia PC
• South Mountain Cardiology
• South Mountain Dental Care Center
• South Mountain Dental Partners LLC
• South Mountain Physical Therapy LLC
• South Mountain Rehabilitation P.C.
• South Mountain Surgery Center, LLC
• South Phoenix Integrity House LLC
• South Phoenix Prep and Arts Academy

• Psychiatric/Mental Health Nurse Practitioner in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Psychiatric/Mental Health Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2021; 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.