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EXTRAORDINARY MINDS
NPI 1538856398
Nurse Practitioner - Psychiatric/Mental Health in Evesham, NJ

Active since April 21, 2023
532 OLD MARLTON PIKE W, SUITE 510, EVESHAM, NJ 08053(856) 242-2121(856) 242-2121 Get Directions Write a Review

NPPES record last updated: April 21, 2023. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Extraordinary Minds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EXTRAORDINARY MINDS (NPI 1538856398) is a healthcare organization registered as a psychiatric/mental health in Evesham, New Jersey and active in the NPI registry since April 2023. The organization lists Karen Wallace, Credentialing, as its authorized official.

NPPES Registry Identity

NPI1538856398
Entity TypeOrganization
Primary Taxonomy363LP0808X
Legal Business NameEXTRAORDINARY MINDS
Location Address532 OLD MARLTON PIKE W, SUITE 510Evesham, NJ 08053
Mailing Address15 Roberts Way SeAcworth, GA 30102-6873 · (470) 446-5360
Phone(856) 242-2121
Fax(856) 242-2121
Organization SubpartNo
Authorized OfficialKaren WallaceCredentialing · (470) 446-5360
Enumeration DateApril 21, 2023
NPPES CertifiedApril 14, 2023
✔ NPI 1538856398 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
532 OLD MARLTON PIKE W, Evesham, NJ 08053
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Extraordinary Minds is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Extraordinary Minds, which bills Medicare for the services they deliver. Of these, 1 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (2)

Tatanisha Hason, APN
Nurse Practitioner
NPI 1013420298
400 E CHURCH ST
Blackwood, NJ 08012
(856) 227-6575
✔ PECOS✔ Accepts Medicare9.8 mi
Ashley Roane, APN
Nurse Practitioner
NPI 1679117774
1511 CLEMENTS BRIDGE RD
Deptford, NJ 08096
(856) 845-9400
✔ PECOS✔ Accepts Medicare11 mi

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 Extraordinary Minds's NPI number?

The NPI number for Extraordinary Minds is 1538856398. It was assigned to this organization in the NPPES registry on April 21, 2023.

Where is Extraordinary Minds located?

Extraordinary Minds is located at 532 Old Marlton Pike W Suite 510, Evesham, NJ 08053. The listed phone number is (856) 242-2121.

What is Extraordinary Minds's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Is Extraordinary Minds enrolled in Medicare?

Yes. Extraordinary Minds is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Extraordinary Minds?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Extraordinary Minds. 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 Extraordinary Minds was last updated on April 21, 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.