IDEAL SELF LLC
NPI 1467182774
Nurse Practitioner - Psychiatric/Mental Health in Phoenix, AZ
About Ideal Self Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
IDEAL SELF LLC (NPI 1467182774) is a healthcare organization registered as a psychiatric/mental health in Phoenix, Arizona and active in the NPI registry since June 2022. The organization lists Angela Childs, Owner/provider, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
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)
Ideal Self Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Ideal Self LLC, which bills Medicare for the services they deliver. Of these, 1 practice within 10 miles. They are listed nearest first.
Clinicians, nearest first (2)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently 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 Ideal Self LLC's NPI number?
The NPI number for Ideal Self LLC is 1467182774. It was assigned to this organization in the NPPES registry on June 10, 2022.
Where is Ideal Self LLC located?
Ideal Self LLC is located at 12620 N Cave Creek Rd Ste 10A, Phoenix, AZ 85022. The listed phone number is (623) 303-6777.
What is Ideal Self LLC's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.
Is Ideal Self LLC enrolled in Medicare?
Yes. Ideal Self LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Ideal Self LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Ideal Self 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. Of these, 1 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Ideal Self LLC was last updated on March 19, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years 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.
# Ideal Self Llc · NPI 1467182774
Psychiatric/Mental Health organization in Phoenix, Arizona. Organization record, active in the CMS NPPES registry since June 10, 2022.
## Identity
- **NPI:** 1467182774 (Entity type: Organization)
- **Enumerated:** June 10, 2022
- **Primary specialty:** Nurse Practitioner - Psychiatric/Mental Health · taxonomy 363LP0808X
- **Organization subpart:** No
- **Authorized official:** Angela Childs, OWNER/PROVIDER
## Practice location
- **Address:** 12620 N CAVE CREEK RD STE 10A, Phoenix, AZ 85022-6528
- **Phone:** (623) 303-6777
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 2 clinicians (Nurse Practitioner) reassign Medicare billing to this organization (form CMS-855R); 1 practice within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** March 19, 2023
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Source: [NPI Profile](https://npiprofile.com/npi/1467182774) · Data from the CMS NPPES public registry.