MAGNOLIA SAGE PSYCHIATRY LLC
NPI 1104785369
Nurse Practitioner - Psychiatric/Mental Health in Surprise, AZ
About Magnolia Sage Psychiatry Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MAGNOLIA SAGE PSYCHIATRY LLC (NPI 1104785369) is a healthcare organization registered as a psychiatric/mental health in Surprise, Arizona and active in the NPI registry since January 2026. The organization holds a CLIA Waiver certificate valid through July 14, 2028 and lists Jessica Pech, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Magnolia Sage Psychiatry Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Magnolia Sage Psychiatry LLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 03D2347274
Magnolia Sage Psychiatry, LLC · Surprise, AZFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Magnolia Sage Psychiatry LLC's NPI number?
The NPI number for Magnolia Sage Psychiatry LLC is 1104785369. It was assigned to this organization in the NPPES registry on January 21, 2026.
Where is Magnolia Sage Psychiatry LLC located?
Magnolia Sage Psychiatry LLC is located at 14239 W Bell Rd Ste 203, Surprise, AZ 85374. The listed phone number is (623) 356-1560.
What is Magnolia Sage Psychiatry LLC's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.
Is Magnolia Sage Psychiatry LLC enrolled in Medicare?
Yes. Magnolia Sage Psychiatry LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Magnolia Sage Psychiatry LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Magnolia Sage Psychiatry LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Magnolia Sage Psychiatry LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 03D2347274) is associated with this NPI, valid through July 14, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Magnolia Sage Psychiatry LLC was last updated on March 6, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Magnolia Sage Psychiatry Llc · NPI 1104785369
Psychiatric/Mental Health organization in Surprise, Arizona. Organization record, active in the CMS NPPES registry since January 21, 2026.
## Identity
- **NPI:** 1104785369 (Entity type: Organization)
- **Enumerated:** January 21, 2026
- **Primary specialty:** Nurse Practitioner - Psychiatric/Mental Health · taxonomy 363LP0808X
- **Organization subpart:** No
- **Authorized official:** Jessica Pech, OWNER
## Practice location
- **Address:** 14239 W BELL RD STE 203, Surprise, AZ 85374-2471
- **Phone:** (623) 356-1560
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Nurse Practitioner) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** March 6, 2026
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1104785369) · Data from the CMS NPPES public registry.