NPIMap

Organization Active NPI

Ely Psychiatric Services LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Cleveland, MS
National Provider Identifier
1609562586
Registry record updated Oct 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
ELY PSYCHIATRIC SERVICES LLC
Practice address
213 N Pearman Ave
Cleveland, MS 38732-2633
Phone
(662) 390-6244
Fax
(949) 561-4976
NPI assigned
Apr 13, 2023
Last updated
Oct 25, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2023

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

Authorized official

Name
Mary Cay Brooks Ely, PMHNP-B.C.
Title
Owner
Phone
(601) 646-7800

Specialties & licenses 1

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

Addresses

Primary practice location

213 N Pearman Ave
Cleveland, MS 38732-2633

Mailing address

PO Box 520
Marion, MS 39342-0520
Phone (601) 646-7700

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240814000243 MS Part B Supplier - Clinic/Group Practice 5193263754 Receives reassigned benefits from 2 practitioners
Practice locations: Leland, MS; Cleveland, MS

National Provider Directory

National Provider Directory

Locations

213 N Pearman Ave
Cleveland, MS 38732
Phone (662) 390-6244

810 E Sunflower Rd
Ste 140
Cleveland, MS 38732
Phone (662) 588-3911

Practitioners & affiliated clinicians

Practitioners 5

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": "1681344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698192000000",
    "number": "1609562586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 520",
            "city": "MARION",
            "state": "MS",
            "postal_code": "393420520",
            "telephone_number": "601-646-7700",
            "fax_number": "888-735-7202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 N PEARMAN AVE",
            "city": "CLEVELAND",
            "state": "MS",
            "postal_code": "387322633",
            "telephone_number": "662-390-6244",
            "fax_number": "949-561-4976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELY PSYCHIATRIC SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-13",
        "last_updated": "2023-10-25",
        "certification_date": "2023-10-25",
        "status": "A",
        "authorized_official_last_name": "ELY",
        "authorized_official_first_name": "MARY CAY",
        "authorized_official_middle_name": "BROOKS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-646-7800",
        "authorized_official_credential": "PMHNP-B.C."
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2023; 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.