NPIMap

Organization Active NPI

Synergy Wellness of Florida Inc.

Doing business as Ellie Mental Health

  • Mental Health Counselor
  • Pembroke Pines, FL
National Provider Identifier
1912630112
Registry record updated Oct 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
SYNERGY WELLNESS OF FLORIDA INC.
Doing business as
Ellie Mental Health
Practice address
9050 Pines Blvd Ste 305
Pembroke Pines, FL 33024-6422
Phone
(630) 205-4664
NPI assigned
Jul 5, 2022
Last updated
Oct 19, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2023

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

Authorized official

Name
Haaris Ali
Title
Owner
Phone
(630) 205-4664

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X NU
Mental Health Counselor 101YM0800X NU Primary
Professional Counselor 101YP2500X NU
Family Medicine Physician 207Q00000X NU
Addiction Medicine (Family Medicine) Physician 207QA0401X NU
Adult Medicine Physician 207QA0505X NU
Child & Adolescent Psychiatry Physician 2084P0804X NU
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU
Adult Mental Health Clinic/Center 261QM0850X NU
Adolescent and Children Mental Health Clinic/Center 261QM0855X NU

Addresses

Primary practice location

9050 Pines Blvd Ste 305
Pembroke Pines, FL 33024-6422

Mailing address

8129 NW 106TH LN
Parkland, FL 33076-4748
Phone (630) 205-4664

Other names 1

  • Ellie Mental Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221205000938 FL Part B Supplier - Clinic/Group Practice 9830568401 Receives reassigned benefits from 9 practitioners
Practice locations: Pembroke Pines, FL

National Provider Directory

National Provider Directory

Locations

2000 NW 150th Ave
Ste 2110
Pembroke Pines, FL 33028
Phone (786) 440-2288

9050 Pines Blvd
Ste 305
Pembroke Pines, FL 33024
Phone (754) 283-9665

Practitioners & affiliated clinicians

Practitioners 23

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.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1656979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697673600000",
    "number": "1912630112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8129 NW 106TH LN",
            "city": "PARKLAND",
            "state": "FL",
            "postal_code": "330764748",
            "telephone_number": "630-205-4664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9050 PINES BLVD STE 305",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330246422",
            "telephone_number": "630-205-4664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SYNERGY WELLNESS OF FLORIDA INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-05",
        "last_updated": "2023-10-19",
        "certification_date": "2023-10-19",
        "status": "A",
        "authorized_official_last_name": "ALI",
        "authorized_official_first_name": "HAARIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "630-205-4664"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ellie Mental Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ellie Mental Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pembroke Pines, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2023; 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.