Elite Psychiatry PC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

ELITE PSYCHIATRY PC

Practice address

3901 Arlington Highlands Blvd Ste 200
Arlington, TX 76018-6050

Phone

(817) 695-5035

Fax

(817) 695-5037

NPI assigned

Jul 20, 2018

Last updated

May 16, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Raven Elliott Modisette, FNP-C, PMHNP-BCNPI 1225580293

Title

C.E.O

Phone

(817) 695-5035

Specialties & licenses 5

Addresses

Other identifiers 2

Other names 1

• Elite Psychiatry PC Former legal business name

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Tax ID family

Elite Psychiatry PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Elite Psychiatry PC

  • Psychiatry Physician
  • Arlington, TX
  • NPI 1770060691
  NPD tax ID

Practitioners 2

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.

• Raven Modisette, FNP-C,PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Arlington, TX
  • NPI 1225580293

  Family

  Medicare reassignment NPD Authorized official
• Ayodele A Abraham, M.D.

  • Child & Adolescent Psychiatry Physician
  • Vernon, TX
  • NPI 1437378999
  Medicare reassignment NPD

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

{
    "created_epoch": "1532044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589587200000",
    "number": "1952888265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 ARLINGTON HIGHLANDS BLVD STE 200",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760186050",
            "telephone_number": "817-695-5035",
            "fax_number": "817-695-5037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 ARLINGTON HIGHLANDS BLVD STE 200",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760186050",
            "telephone_number": "817-695-5035",
            "fax_number": "817-695-5037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE PSYCHIATRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-20",
        "last_updated": "2020-05-16",
        "certification_date": "2020-05-16",
        "status": "A",
        "authorized_official_last_name": "MODISETTE",
        "authorized_official_first_name": "RAVEN",
        "authorized_official_middle_name": "ELLIOTT",
        "authorized_official_title_or_position": "C.E.O",
        "authorized_official_telephone_number": "817-695-5035",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "FNP-C, PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": "TX",
            "license": "M9770",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TX MEDICAL BOARD",
            "identifier": "M9770",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APRN LICENSE NUMBER",
            "identifier": "AP137299",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elite Psychiatry PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Psychiatry Physician in Arlington, TX
• Providers in Arlington, TX by specialty
• Psychiatry Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2020; 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.