NPIMap

Organization Active NPI

Fiveshine Corporation

Doing business as Ellie Mental Health

  • Clinical Social Worker
  • Orlando, FL
National Provider Identifier
1356184121
Registry record updated Jun 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
FIVESHINE CORPORATION
Doing business as
Ellie Mental Health
Practice address
3680 Avalon Park East Blvd Ste 301
Orlando, FL 32828-9372
Phone
(407) 928-1425
NPI assigned
Jun 18, 2024
Last updated
Jun 18, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2024

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

Authorized official

Name
Jamie E Olofson
Title
President
Phone
(407) 928-1425

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

3680 Avalon Park East Blvd Ste 301
Orlando, FL 32828-9372

Mailing address

11506 Brightstowe Way
Orlando, FL 32836-8844
Phone (407) 758-9959

Other names 1

  • Ellie Mental Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250305000080 FL Part B Supplier - Clinic/Group Practice 2961923198 Receives reassigned benefits from 9 practitioners
Practice locations: Orlando, FL

National Provider Directory

National Provider Directory

Locations

3680 E Avalon Park Blvd
Ste 301
Orlando, FL 32828
Phone (321) 351-4925

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1718668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718668800000",
    "number": "1356184121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11506 BRIGHTSTOWE WAY",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328368844",
            "telephone_number": "407-758-9959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3680 AVALON PARK EAST BLVD STE 301",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328289372",
            "telephone_number": "407-928-1425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIVESHINE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-18",
        "last_updated": "2024-06-18",
        "certification_date": "2024-06-18",
        "status": "A",
        "authorized_official_last_name": "OLOFSON",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "407-928-1425"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ellie Mental Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 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.

Verify at the official NPI Registry.