NPIMap

Organization Active NPI

Newlight Psychiatric Services Inc

  • Psychiatric/Mental Health Nurse Practitioner
  • Lakeland, FL
National Provider Identifier
1477058691
Registry record updated Aug 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
ARNP9253922 Issued in FL
Legal business name
NEWLIGHT PSYCHIATRIC SERVICES INC
Practice address
5302 S Florida Ave Ste 203
Lakeland, FL 33813-4910
Phone
(863) 602-7001
NPI assigned
Mar 28, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2024

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

Authorized official

Name
Panchami Thomas, ARNPNPI 1336689819
Title
President
Phone
(727) 424-8419

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP0808X ARNP9253922 FL Primary

Addresses

Primary practice location

5302 S Florida Ave Ste 203
Lakeland, FL 33813-4910

Mailing address

2832 Gallagher Rd
Dover, FL 33527-5308
Phone (727) 424-8419

Other practice location 1

106 W Windhorst Rd
Brandon, FL 33510-2455
Phone (813) 373-9531

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180726001069 FL Part B Supplier - Clinic/Group Practice 9931456605 Receives reassigned benefits from 7 practitioners
Practice locations: Lakeland, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1522195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723680000000",
    "number": "1477058691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2832 GALLAGHER RD",
            "city": "DOVER",
            "state": "FL",
            "postal_code": "335275308",
            "telephone_number": "727-424-8419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5302 S FLORIDA AVE STE 203",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338134910",
            "telephone_number": "863-602-7001"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "106 W Windhorst Rd",
            "address_purpose": "LOCATION",
            "city": "Brandon",
            "state": "FL",
            "postal_code": "335102455",
            "country_code": "US",
            "telephone_number": "813-373-9531",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NEWLIGHT PSYCHIATRIC SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-28",
        "last_updated": "2024-08-15",
        "certification_date": "2024-08-15",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "PANCHAMI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "727-424-8419",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "ARNP9253922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeland, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 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.