NPIMap

Organization Active NPI

Awesome Minds Psychiatric LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Wesley Chapel, FL
National Provider Identifier
1528753290
Registry record updated Apr 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
AWESOME MINDS PSYCHIATRIC LLC
Practice address
31233 Claridge PL
Wesley Chapel, FL 33543-5014
Phone
(407) 255-3310
NPI assigned
Apr 10, 2023
Last updated
Apr 28, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2024

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

Authorized official

Name
Al Berry
Title
Credentialing Manager
Phone
(469) 915-4211

Specialties & licenses 1

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

Addresses

Primary practice location

31233 Claridge PL
Wesley Chapel, FL 33543-5014

Mailing address

31233 Claridge PL
Wesley Chapel, FL 33543-5014
Phone (000) 000-0000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230426000312 FL Part B Supplier - Clinic/Group Practice 5991160053 Receives reassigned benefits from 1 practitioner
Practice locations: Sarasota, FL; Wesley Chapel, FL

National Provider Directory

National Provider Directory

Locations

28210 Paseo Dr
#241
Wesley Chapel, FL 33543
Phone (407) 255-3310

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1681084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714262400000",
    "number": "1528753290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31233 CLARIDGE PL",
            "city": "WESLEY CHAPEL",
            "state": "FL",
            "postal_code": "335435014",
            "telephone_number": "000-000-0000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31233 CLARIDGE PL",
            "city": "WESLEY CHAPEL",
            "state": "FL",
            "postal_code": "335435014",
            "telephone_number": "407-255-3310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AWESOME MINDS PSYCHIATRIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-10",
        "last_updated": "2024-04-28",
        "certification_date": "2024-04-28",
        "status": "A",
        "authorized_official_last_name": "BERRY",
        "authorized_official_first_name": "AL",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "469-915-4211"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wesley Chapel, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 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.