NPIMap

Organization Active NPI

County of Otsego

Doing business as Otsego County Chemical Dependencies Clinic

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Oneonta, NY
National Provider Identifier
1104925031
Registry record updated Mar 29, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
COUNTY OF OTSEGO
Doing business as
Otsego County Chemical Dependencies Clinic
Practice address
242 Main Street,
2ND Floor
Oneonta, NY 13820-2527
Phone
(607) 431-1030
Fax
(607) 431-1033
NPI assigned
Sep 21, 2006
Last updated
Mar 29, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2017

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

Authorized official

Name
Ms. Susan A Matt, LCSW/CASACNPI 1891735429
Title
Director of Community Services
Phone
(607) 433-2343

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

242 Main Street,
2ND Floor
Oneonta, NY 13820-2527

Mailing address

242 Main Street,
2ND Floor
Oneonta, NY 13820-2527
Phone (607) 431-1030

Other identifiers 1

IdentifierTypeStateIssuer
00583582MedicaidNY

Other names 1

  • Otsego County Chemical Dependencies Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111101000022 NY Part B Supplier - Clinic/Group Practice 9032195573 Receives reassigned benefits from 5 practitioners
Practice locations: Oneonta, NY

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Meadows County of Otseg11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Locations

242 Main St
Ste 2
Oneonta, NY 13820
Phone (607) 431-1030

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490745600000",
    "number": "1104925031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "242 MAIN STREET,",
            "address_2": "2ND FLOOR",
            "city": "ONEONTA",
            "state": "NY",
            "postal_code": "138202527",
            "telephone_number": "607-431-1030",
            "fax_number": "607-431-1033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "242 MAIN STREET,",
            "address_2": "2ND FLOOR",
            "city": "ONEONTA",
            "state": "NY",
            "postal_code": "138202527",
            "telephone_number": "607-431-1030",
            "fax_number": "607-431-1033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF OTSEGO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2017-03-29",
        "status": "A",
        "authorized_official_last_name": "MATT",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DIRECTOR OF COMMUNITY SERVICES",
        "authorized_official_telephone_number": "607-433-2343",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW/CASAC"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00583582",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Otsego County Chemical Dependencies Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oneonta, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2017; 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.