NPIMap

Organization Active NPI

Oasis Behavioral Health LLC

Doing business as Spark Wellness Group

  • Psychiatry Physician
  • Orlando, FL
National Provider Identifier
1508531195
Registry record updated Aug 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
OASIS BEHAVIORAL HEALTH LLC
Doing business as
Spark Wellness Group
Practice address
6900 Tavistock Lakes Blvd Ste 400-412
Orlando, FL 32827-7589
Phone
(321) 340-3490
Fax
(321) 340-4755
NPI assigned
Aug 16, 2021
Last updated
Aug 16, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2021

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

Authorized official

Name
Luis Emilio Betancourt, MDNPI 1891076022
Title
Co-Owner
Phone
(704) 770-7027

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
Psychiatry Physician 2084P0800X NU Primary

Addresses

Primary practice location

6900 Tavistock Lakes Blvd Ste 400-412
Orlando, FL 32827-7589

Mailing address

10026 Hatton Cir
Orlando, FL 32832-6174
Phone (321) 340-3490

Other names 1

  • Spark Wellness Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260430001356 FL Part B Supplier - Clinic/Group Practice 1355818030 Receives reassigned benefits from 12 practitioners
Practice locations: Orlando, FL

National Provider Directory

National Provider Directory

Locations

13571 Narcoossee Rd
Orlando, FL 32832
Phone (321) 340-3490

6900 Tavistock Lakes Blvd
Ste 400412
Orlando, FL 32827
Phone (321) 340-3490

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1629072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629072000000",
    "number": "1508531195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10026 HATTON CIR",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328326174",
            "telephone_number": "321-340-3490",
            "fax_number": "321-340-4755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6900 TAVISTOCK LAKES BLVD STE 400-412",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328277589",
            "telephone_number": "321-340-3490",
            "fax_number": "321-340-4755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OASIS BEHAVIORAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-16",
        "last_updated": "2021-08-16",
        "certification_date": "2021-08-13",
        "status": "A",
        "authorized_official_last_name": "BETANCOURT",
        "authorized_official_first_name": "LUIS",
        "authorized_official_middle_name": "EMILIO",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "704-770-7027",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Spark Wellness Group",
            "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 Aug 16, 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.