Operation Lifestyle Redesign Group LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

OPERATION LIFESTYLE REDESIGN GROUP LLC

Practice address

83 Wooster Heights
Suite #125
Danbury, CT 06810

Phone

(203) 957-3938

Fax

(866) 266-4842

NPI assigned

Sep 17, 2021

Organization subpart

No

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

Authorized official

Name

Mr. Brandon Davar Pervis Sr., APRNNPI 1821405127

Title

Vice President of Clinical Operatio

Phone

(203) 957-3938

Specialties & licenses 3

Addresses

Other names 2

• Emerald Wellness Doing business as
• Lifestyle Redesign 77 Doing business as

Practitioners 1

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

• Brandon Pervis Sr., APRN, FNP-C

  • Family Nurse Practitioner
  • Danbury, CT
  • NPI 1821405127
  NPD Authorized official

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

{
    "created_epoch": "1631836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631836800000",
    "number": "1972273282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 DIXWELL AVE STE 278",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065113403",
            "telephone_number": "203-957-3938",
            "fax_number": "866-266-4842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "83 WOOSTER HEIGHTS",
            "address_2": "SUITE #125",
            "city": "DANBURY",
            "state": "CT",
            "postal_code": "06810",
            "telephone_number": "203-957-3938",
            "fax_number": "866-266-4842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPERATION LIFESTYLE REDESIGN GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-17",
        "last_updated": "2021-09-17",
        "certification_date": "2021-08-20",
        "status": "A",
        "authorized_official_last_name": "PERVIS",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_middle_name": "DAVAR",
        "authorized_official_title_or_position": "VICE PRESIDENT OF CLINICAL OPERATIO",
        "authorized_official_telephone_number": "203-957-3938",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Emerald Wellness",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lifestyle Redesign 77",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lawrence Ogweno Olala, PA
• Suzanne B Oliveri, OTR/L
• Aparna Oltikar, M.D.
• Opeyemi Omobolanle Omosebi, M.D.
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• Opticare Eye Health Centers, Inc.
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• Darcy L. Orcutt-Wilczak, LMFT
• Jeraldine S Orlina, MD
• Nicole Orrico

• Mental Health Clinic/Center (Including Community Mental Health Center) in Danbury, CT
• Providers in Danbury, CT by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.