NPIMap

Organization Active NPI

Sunrise Counseling Services, PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Clermont, FL
National Provider Identifier
1710624101
Registry record updated Jun 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
SUNRISE COUNSELING SERVICES, PLLC
Practice address
297 E Highway 50 Ste 1
Clermont, FL 34711-2500
Phone
(407) 205-5589
NPI assigned
May 17, 2022
Last updated
Jun 27, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2024

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

Authorized official

Name
Roberto Gouthman, DONPI 1437688702
Title
Medical Director
Phone
(786) 843-5463

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
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU Primary

Addresses

Primary practice location

297 E Highway 50 Ste 1
Clermont, FL 34711-2500

Mailing address

6939 Green Swamp Rd
Clermont, FL 34714-9729
Phone (140) 720-5558

Other identifiers 1

IdentifierTypeStateIssuer
1019414110002MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cpozzi@devereux.org Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240802001254 FL Part B Supplier - Clinic/Group Practice 4385181759 Receives reassigned benefits from 5 practitioners
Practice locations: Clermont, FL; Sunrise, FL; Plantation, FL

National Provider Directory

National Provider Directory

Locations

297 E Highway 50
Ste 1
Clermont, FL 34711
Phone (352) 404-6589

4577 N Nob Hill Rd
Ste 106
Sunrise, FL 33351
Phone (352) 404-6589

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1652745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719446400000",
    "number": "1710624101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6939 GREEN SWAMP RD",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347149729",
            "telephone_number": "140-720-5558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "297 E HIGHWAY 50 STE 1",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347112500",
            "telephone_number": "407-205-5589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNRISE COUNSELING SERVICES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-17",
        "last_updated": "2024-06-27",
        "certification_date": "2024-06-27",
        "status": "A",
        "authorized_official_last_name": "GOUTHMAN",
        "authorized_official_first_name": "ROBERTO",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "786-843-5463",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1019414110002",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cpozzi@devereux.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "297 E Highway 50 Ste 1",
            "city": "Clermont",
            "state": "FL",
            "country_code": "US",
            "postal_code": "347112500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Clermont, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 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.