Polk County-Dept of Administration

PAC ID

4587560586The PECOS associate control ID: one enrolled organization, which may hold several NPIs

Provider type

Part A Provider - Skilled Nursing Facility, Part B Supplier - Clinic/Group Practice, Part B Supplier - Mass Immunization (Roster Biller Only)

Enrolled in

WI

Enrollments

3

Group size

2 cliniciansAs Care Compare reports it

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice locations

3In 2 places

Enrollment records 3

These NPI records belong to the same enrolled organization. Each has its own page.

• Polk County Dept of Administration

  • Community/Behavioral Health Agency
  • Balsam Lake, WI
  • NPI 1083837298
• Polk County-Dept of Administration

  • Nursing Facility/Intermediate Care Facility
  • Amery, WI
  • NPI 1215981998
• Polk County-Dept of Administration

  dba Polk County Health Dept/Healthcheck

  • Public Health or Welfare Agency
  • Balsam Lake, WI
  • NPI 1295964435

Clinicians who reassign their Medicare benefits to this group (4) or whom Care Compare lists as members (2).

• Stephanie Lynne Burrows, MD

  • Psychiatry Physician
  • Wakefield, MI
  • NPI 1063525608
• Kelly L Henry, MSW, LISW-S

  • Clinical Social Worker
  • Zanesville, OH
  • NPI 1760936165
• Brian Longhurst Merrill, DO

  • Psychiatry Physician
  • Balsam Lake, WI
  • NPI 1982648929
• Kevin J Montague, MS, LPC, LSAC, LSW

  • Professional Counselor
  • Balsam Lake, WI
  • NPI 1992078828

• Medicare Fee-For-Service Public Provider Enrollment: the enrollments, PAC ID, practice locations and benefit reassignments.
• Care Compare Doctors and Clinicians: group membership, group size and the name CMS shows patients.
• NPPES NPI Registry: the names and addresses of the NPIs above.