NPIMap

Organization Active NPI

Mile High Psychiatry LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Scottsdale, AZ
National Provider Identifier
1366099020
Registry record updated Nov 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
MILE HIGH PSYCHIATRY LLC
Practice address
13430 N Scottsdale Rd Ste 104-6
Scottsdale, AZ 85254-4057
Phone
(720) 507-4779
Fax
(720) 367-5067
NPI assigned
Aug 19, 2019
Last updated
Nov 4, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
MILE HIGH PSYCHIATRY LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 4, 2022

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

Authorized official

Name
Michael Keith ChismNPI 1154780757
Title
Ceo/Psychiatric Director
Phone
(720) 507-4779

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X Primary

Addresses

Primary practice location

13430 N Scottsdale Rd Ste 104-6
Scottsdale, AZ 85254-4057

Mailing address

15355 E Colfax Ave Unit 111717
Aurora, CO 80042-1975
Phone (720) 507-4779

Other names 1

  • Mile High Psychiatry Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220927002730 AZ Part B Supplier - Clinic/Group Practice 9032459656 Practice locations: Scottsdale, AZ

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Part of
Mile High Psychiatry LLC

Locations

10810 N Tatum Blvd
Ste 102142
Phoenix, AZ 85028

2550 W Union Hills Dr
Ste 3507358
Phoenix, AZ 85027

3330 N 2nd St
Ste 500
Phoenix, AZ 85012
Phone (602) 910-0069

Practitioners & affiliated clinicians

Practitioners 2

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": "1566172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667520000000",
    "number": "1366099020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15355 E COLFAX AVE UNIT 111717",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800421975",
            "telephone_number": "720-507-4779",
            "fax_number": "720-367-5067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13430 N SCOTTSDALE RD STE 104-6",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852544057",
            "telephone_number": "720-507-4779",
            "fax_number": "720-367-5067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILE HIGH PSYCHIATRY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MILE HIGH PSYCHIATRY LLC",
        "enumeration_date": "2019-08-19",
        "last_updated": "2022-11-04",
        "certification_date": "2022-11-04",
        "status": "A",
        "authorized_official_last_name": "CHISM",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "KEITH",
        "authorized_official_title_or_position": "CEO/PSYCHIATRIC DIRECTOR",
        "authorized_official_telephone_number": "720-507-4779"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mile High Psychiatry",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Mile High Psychiatry",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Scottsdale, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2022; 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.