NPIMap

Organization Active NPI

Spectrum Behavioral Health LLC

  • Community/Behavioral Health Agency
  • Green Bay, WI
National Provider Identifier
1053718890
Registry record updated Jun 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
4151-125 Issued in WI
Legal business name
SPECTRUM BEHAVIORAL HEALTH LLC
Practice address
1496 Bellevue St
Suite 101
Green Bay, WI 54311-4205
Phone
(920) 784-2644
NPI assigned
Nov 21, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2015

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

Authorized official

Name
Linda A Carmody, MS, LPC
Title
Clinic Director
Phone
(920) 784-2646

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 4151-125 WI Primary
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X 1826-33 WI

Addresses

Primary practice location

1496 Bellevue St
Suite 101
Green Bay, WI 54311-4205

Mailing address

1496 Bellevue St
Suite 101
Green Bay, WI 54311-4205
Phone (920) 784-2644

Other identifiers 1

IdentifierTypeStateIssuer
100043151MedicaidWI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150626000303 WI Part B Supplier - Clinic/Group Practice 2961713359 Receives reassigned benefits from 2 practitioners
Practice locations: Green Bay, WI

National Provider Directory

National Provider Directory

Locations

1496 Bellevue St
Ste 101
Green Bay, WI 54311
Phone (920) 784-2644

1496 Bellevue St
#101
Green Bay, WI 54311
Phone (920) 784-2644

Practitioners & affiliated clinicians

Practitioners 10

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

NPI Registry JSON

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

{
    "created_epoch": "1416528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434499200000",
    "number": "1053718890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1496 BELLEVUE ST",
            "address_2": "SUITE 101",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543114205",
            "telephone_number": "920-784-2644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1496 BELLEVUE ST",
            "address_2": "SUITE 101",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543114205",
            "telephone_number": "920-784-2644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM BEHAVIORAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-21",
        "last_updated": "2015-06-17",
        "status": "A",
        "authorized_official_last_name": "CARMODY",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "920-784-2646",
        "authorized_official_credential": "MS, LPC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "WI",
            "license": "4151-125",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WI",
            "license": "1826-33",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100043151",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2015; 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.