NPIMap

Organization Active NPI

Van Buren Community Mental Health Authority

  • Psychiatry Physician
  • Paw Paw, MI
National Provider Identifier
1003878554
Registry record updated Jan 31, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
VAN BUREN COMMUNITY MENTAL HEALTH AUTHORITY
Practice address
801 Hazen St
Ste C
Paw Paw, MI 49079-0249
Phone
(269) 657-5574
Fax
(269) 657-3474
NPI assigned
Apr 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2008

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

Authorized official

Name
Mrs. Debra Hess, CEO
Title
Chief Executive Officer
Phone
(269) 657-5574

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

801 Hazen St
Ste C
Paw Paw, MI 49079-0249

Mailing address

PO Box 249
801 Hazen St Ste C
Paw Paw, MI 49079-0249
Phone (269) 657-5574

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081119000149 MI Part B Supplier - Clinic/Group Practice 6800863788 Receives reassigned benefits from 31 practitioners
Practice locations: South Haven, MI; Hartford, MI; Bangor, MI; Paw Paw, MI

National Provider Directory

National Provider Directory

Locations

61899 M 43
Bangor, MI 49013
Phone (269) 427-5671

1007 Wells St
South Haven, MI 49090
Phone (269) 637-5297

Practitioners & affiliated clinicians

Practitioners 52

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

View all 52

NPI Registry JSON

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

{
    "created_epoch": "1144022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201737600000",
    "number": "1003878554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 249",
            "address_2": "801 HAZEN ST STE C",
            "city": "PAW PAW",
            "state": "MI",
            "postal_code": "490790249",
            "telephone_number": "269-657-5574",
            "fax_number": "269-657-3474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 HAZEN ST",
            "address_2": "STE C",
            "city": "PAW PAW",
            "state": "MI",
            "postal_code": "490790249",
            "telephone_number": "269-657-5574",
            "fax_number": "269-657-3474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VAN BUREN COMMUNITY MENTAL HEALTH AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-03",
        "last_updated": "2008-01-31",
        "status": "A",
        "authorized_official_last_name": "HESS",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "269-657-5574",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Paw Paw, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.