Optum Behavioral Care of Colorado, P.C.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

OPTUM BEHAVIORAL CARE OF COLORADO, P.C.

Practice address

914 N San Francisco St
Flagstaff, AZ 86001-3254

Phone

(704) 506-6267

NPI assigned

Jan 5, 2024

Organization subpart

No

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

Authorized official

Name

Leslie Johnson

Title

Ceo

Phone

(704) 506-6267

Specialties & licenses 1

Addresses

Other names 1

• Phoenix Mental Health and Wellness of Arizona Doing business as

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Optum Behavioral Care of Colorado, P.C.

  • Clinical Psychologist
  • Show Low, AZ
  • NPI 1568272698

  O20240717001855

  Same enrollment
• Optum Behavioral Care of Colorado, P.C.

  • Clinical Psychologist
  • Mesa, AZ
  • NPI 1942070370

  O20240717001855

  Same enrollment
• Optum Behavioral Care of Colorado, P.C.

  • Clinical Social Worker
  • Tempe, AZ
  • NPI 1972480069

  O20240717001855

  Same enrollment

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Eva R Besmanoff, LCSW

  • Clinical Social Worker
  • Tempe, AZ
  • NPI 1598062275
  NPD
• Samantha Lynne Kragel, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Tempe, AZ
  • NPI 1215694773
  NPD
• Joseph Peter Tris, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Flagstaff, AZ
  • NPI 1881946978
  NPD

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

{
    "created_epoch": "1704412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713916800000",
    "number": "1932979366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11000 OPTUM CIR",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553442503",
            "telephone_number": "704-506-6267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "914 N SAN FRANCISCO ST",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860013254",
            "telephone_number": "704-506-6267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTUM BEHAVIORAL CARE OF COLORADO, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-05",
        "last_updated": "2024-04-24",
        "certification_date": "2024-04-24",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "704-506-6267"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Phoenix Mental Health and Wellness of Arizona",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Hailey Omay
• Susanne One Love, RN
• Ophthalmic Anesthesia Services
• Sara Grace Oppliger, CCC-SLP
• Optum Behavioral Care of Colorado, P.C.
• Oral and Maxillofacial Surgeons of Northern Arizona
• Christopher Kevin Oros, D.O.
• Neina Orrillo, CRNA
• Catherine Mariah Orth
• Orthodontics of Flagstaff PC

• Clinical Psychologist in Flagstaff, AZ
• Providers in Flagstaff, AZ by specialty
• Clinical Psychologist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 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.