Surprise Behavioral Hospital LP

Primary specialty

Psychiatric HospitalTaxonomy code 283Q00000X

Legal business name

SURPRISE BEHAVIORAL HOSPITAL LP

Practice address

16561 North Parkview Place
Surprise, AZ 85374

Phone

(602) 615-1453

NPI assigned

Oct 3, 2018

Last updated

Apr 14, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Burton Timothy Carriker, MSNPI 1851281349

Title

Executive Director / Board Member

Phone

(623) 522-4525

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649755893. Details of each certification follow.

• CCN 034035 Hospital · Active · Details

Hospital certification: CCN 034035

Legal name

SURPRISE BEHAVIORAL HOSPITAL LP

Doing business as

AVENIR BEHAVIORAL HEALTH CENTER

Certification status

Active

Provider type (POS)

Hospital – Psychiatric

Participating since

Feb 12, 2020

Last certification

Feb 12, 2020

Beds

32

Ownership / control type

Private (for profit)

Organization structure

PartnershipProprietary

Incorporated

Jan 31, 2017 in AZ

Enrollment address

16561 N Parkview PL
Surprise, AZ 85374-7499
Other Hospital Practice Location

Hospital subgroups

Psychiatric

Listed as

Avenir Behavioral Health CenterCCN 034035 · All quality measures

Type

Psychiatric

Ownership

Proprietary

Medicare certification status

ActiveFrom the Provider of Services file

Emergency services

No

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 14

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Practitioners 10

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.

• Burton Timothy Carriker, LPC004623

  • Professional Counselor
  • Ave Maria, FL
  • NPI 1851281349
  NPD Authorized official
• Eric J. Perry, M.S.

  • Addiction (Substance Use Disorder) Counselor
  • Avondale, AZ
  • NPI 1417107715
  NPD
• Saurabh Jauhari, MD

  • Psychiatry Physician
  • Glendale, AZ
  • NPI 1558507707
  NPD (past)
• Rosekamal McKinney, M.D.

  • Addiction Medicine (Preventive Medicine) Physician
  • Glendale, AZ
  • NPI 1457794885
  NPD (past)
• Chineme Moneke, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Glendale, AZ
  • NPI 1427784263
  NPD (past)
• Varun Monga, MBBS

  • Psychiatry Physician
  • Glendale, AZ
  • NPI 1639457096
  NPD (past)
• Jennifer Plenty, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Phoenix, AZ
  • NPI 1437878659
  NPD (past)
• Kari Lynne Robinson, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Litchfield Park, AZ
  • NPI 1568159226
  NPD (past)
• Sarbjit Singh, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Glendale, AZ
  • NPI 1184293490
  NPD (past)
• Martin Romeo Tamou, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Phoenix, AZ
  • NPI 1114785953
  NPD (past)

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

{
    "created_epoch": "1538524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586822400000",
    "number": "1649755893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7611 E PASARO DR",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852662774",
            "telephone_number": "480-316-3708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16561 NORTH PARKVIEW PLACE",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "85374",
            "telephone_number": "602-615-1453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURPRISE BEHAVIORAL HOSPITAL LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-03",
        "last_updated": "2020-04-14",
        "certification_date": "2020-04-14",
        "status": "A",
        "authorized_official_last_name": "CARRIKER",
        "authorized_official_first_name": "BURTON",
        "authorized_official_middle_name": "TIMOTHY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR / BOARD MEMBER",
        "authorized_official_telephone_number": "623-522-4525",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MS"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric Hospital in Surprise, AZ
• Providers in Surprise, AZ by specialty
• Psychiatric Hospital in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.