Individual provider Active NPI

Theresa Masonbrink, APRN, CNS

  • Psychiatric/Mental Health Nurse Practitioner
  • North Olmsted, OH
National Provider Identifier
1770805277
Registry record updated Jul 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
APRN.CNS.11227 Issued in OH
Practice address
25111 Country Club Blvd Ste 290
North Olmsted, OH 44070-5330
Phone
(216) 468-5000
NPI assigned
Feb 24, 2010
Last updated
Jul 8, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2025

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 0024185167 VA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 4704276138 MI
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 101.0136168TELE VT
Psychiatric/Mental Health Nurse Practitioner 363LP0808X APRN.CNS.11227 OH Primary
Adult Psychiatric/Mental Health Clinical Nurse Specialist 364SP0809X 5031 CA

Addresses

Primary practice location

25111 Country Club Blvd Ste 290
North Olmsted, OH 44070-5330

Mailing address

4800 N Scottsdale Rd Ste 2500
Scottsdale, AZ 85251-7630
Phone (216) 468-5000

Other practice location 1

2285 Benden Dr
Wooster, OH 44691-2568
Phone (302) 649-0293

Other names 1

  • Theresa Markovich, Lambert Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, VT2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20120402000460 OH Practitioner - Certified Clinical Nurse Specialist (CNS) 3476713249 Reassigns benefits to 1 organization
I20230619000107 VT Practitioner - Nurse Practitioner 3476713249 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Clinical Nurse Specialist (CNS)
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Psychological and Behavioral Consultants LLCGroup PAC ID 0446243760, 595 clinicians

Practice addresses (Care Compare)

25111 Country Club Blvd
Suite 290
North Olmsted, OH 44070-5330
Phone (440) 614-2520

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Specialist, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
5031CAMDOptometrist
4704276138MIMDPsychiatric/Mental Health Nurse Practitioner
0024185167VAMDPsychiatric/Mental Health Nurse Practitioner
101.0136168TELEVTMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Kingdom Human Services Inc CurrentSince Jun 1, 2023 Accepting new patients
Psychological & Behavioral Consultants, LLC CurrentSince Jul 28, 2025 Accepting new patients
Darke County Mental Health Clinic, Inc PastSince Mar 2, 2015 Accepting new patients

Locations

4800 N Scottsdale Rd
Ste 2500
Scottsdale, AZ 85251
Phone (253) 346-0392

25111 Country Club Blvd
Ste 290
North Olmsted, OH 44070
Phone (440) 614-2520

2225 Portland St
St Johnsbury, VT 05819
Phone (802) 748-3181

Interoperability endpoints

  • Direct secure messaging: lifestancehealth.theresamasonbrink@140094.advancedmd-direct.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1266969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751932800000",
    "number": "1770805277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 N SCOTTSDALE RD STE 2500",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852517630",
            "telephone_number": "216-468-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25111 COUNTRY CLUB BLVD STE 290",
            "city": "NORTH OLMSTED",
            "state": "OH",
            "postal_code": "440705330",
            "telephone_number": "216-468-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2285 Benden Dr",
            "address_purpose": "LOCATION",
            "city": "Wooster",
            "state": "OH",
            "postal_code": "446912568",
            "country_code": "US",
            "telephone_number": "302-649-0293",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MASONBRINK",
        "first_name": "THERESA",
        "credential": "APRN, CNS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-02-24",
        "last_updated": "2025-07-08",
        "certification_date": "2025-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "VA",
            "license": "0024185167",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MI",
            "license": "4704276138",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "VT",
            "license": "101.0136168TELE",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OH",
            "license": "APRN.CNS.11227",
            "primary": true
        },
        {
            "code": "364SP0809X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health, Adult",
            "state": "CA",
            "license": "5031",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "THERESA",
            "last_name": "MARKOVICH, LAMBERT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in North Olmsted, OH

Sources for this page

Verify at the official NPI Registry.