NPIMap

Organization Active NPI

Mind Rejuvenation, LLC.

  • Psychiatry Physician
  • Tulsa, OK
National Provider Identifier
1811527518
Registry record updated Mar 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
MIND REJUVENATION, LLC.
Practice address
4922 E 73Rd St
Tulsa, OK 74136-7007
Phone
(918) 392-4550
Fax
(918) 392-4551
NPI assigned
Jan 22, 2020
Last updated
Mar 3, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2026

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

Authorized official

Name
Peggy Sue Shearl
Title
Office Manager
Phone
(918) 340-6460

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X Primary

Addresses

Primary practice location

4922 E 73Rd St
Tulsa, OK 74136-7007

Mailing address

4922 E 73Rd St
Tulsa, OK 74136-7007
Phone (918) 340-6460

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230920003665 OK Part B Supplier - Clinic/Group Practice 9335593672 Receives reassigned benefits from 6 practitioners
Practice locations: Tulsa, OK

National Provider Directory

National Provider Directory

Locations

4922 E 73rd St
Tulsa, OK 74136
Phone (918) 340-6460

Practitioners & affiliated clinicians

Practitioners 12

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": "1579651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772496000000",
    "number": "1811527518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4922 E 73RD ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741367007",
            "telephone_number": "918-340-6460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4922 E 73RD ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741367007",
            "telephone_number": "918-392-4550",
            "fax_number": "918-392-4551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND REJUVENATION, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-22",
        "last_updated": "2026-03-03",
        "certification_date": "2026-03-03",
        "status": "A",
        "authorized_official_last_name": "SHEARL",
        "authorized_official_first_name": "PEGGY",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "918-340-6460"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2026; 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.