NPIMap

Organization Active NPI

Mind Spa LLC

  • Psychiatry Physician
  • Tulsa, OK
National Provider Identifier
1891932216
Registry record updated Sep 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
4200 Issued in OK
Legal business name
MIND SPA LLC
Practice address
7302 S Yale Ave
Tulsa, OK 74136-7027
Phone
(918) 591-2510
Fax
(918) 591-2511
NPI assigned
Jan 8, 2009
Last updated
Sep 30, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2022

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

Authorized official

Name
Dr. Sarah E Land, D.O.NPI 1700956406
Title
Owner/Mind Spa LLC
Phone
(918) 591-2510

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU
Clinical Social Worker 1041C0700X 2641 OK
Licensed Practical Nurse 164W00000X 63489 OK
Psychiatry Physician 2084P0800X 4200 OK Primary

Addresses

Primary practice location

7302 S Yale Ave
Tulsa, OK 74136-7027

Mailing address

7302 S Yale Ave
Tulsa, OK 74136-7027
Phone (918) 591-2510

Other identifiers 2

IdentifierTypeStateIssuer
200060070AMedicaidOK
200225500AMedicaidOK

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130903000495 OK Part B Supplier - Clinic/Group Practice 6608019120 Receives reassigned benefits from 8 practitioners
Practice locations: Tulsa, OK

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
37D2091841Mind Spa, LLC7302 S Yale Ave, Tulsa, OK 74136Certificate of waiverFeb 19, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

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": "1231372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664496000000",
    "number": "1891932216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7302 S YALE AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741367027",
            "telephone_number": "918-591-2510",
            "fax_number": "918-591-2511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7302 S YALE AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741367027",
            "telephone_number": "918-591-2510",
            "fax_number": "918-591-2511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND SPA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-08",
        "last_updated": "2022-09-30",
        "certification_date": "2022-09-30",
        "status": "A",
        "authorized_official_last_name": "LAND",
        "authorized_official_first_name": "SARAH",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER/MIND SPA LLC",
        "authorized_official_telephone_number": "918-591-2510",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OK",
            "license": "2641",
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OK",
            "license": "63489",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OK",
            "license": "4200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200060070A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200225500A",
            "state": "OK"
        }
    ],
    "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 Sep 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.