NPIMap

Organization Active NPI

Birchwood Wellness

  • Multi-Specialty Clinic/Center
  • Ankeny, IA
National Provider Identifier
1124405055
Registry record updated Jul 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
BIRCHWOOD WELLNESS
Practice address
6950 NE 14TH St Ste 36
Ankeny, IA 50023-8903
Phone
(515) 289-1515
Fax
(515) 289-1511
NPI assigned
Apr 29, 2015
Last updated
Jul 30, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2021

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

Authorized official

Name
Megan Elise Otto CavesNPI 1639458433
Title
Licensed Psychologist
Phone
(515) 289-1515

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU Primary
Psychiatric/Mental Health Clinical Nurse Specialist 364SP0808X G-108504 IA
Psychologist 103T00000X 001268 IA

Addresses

Primary practice location

6950 NE 14TH St Ste 36
Ankeny, IA 50023-8903

Mailing address

6950 NE 14TH St Ste 36
Ankeny, IA 50023-8903
Phone (515) 289-1515

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150626000617 IA Part B Supplier - Clinic/Group Practice 7214249606 Receives reassigned benefits from 2 practitioners
Practice locations: Ankeny, IA

National Provider Directory

National Provider Directory

Locations

6900 NE 14th St
Ste 29
Ankeny, IA 50023
Phone (515) 289-1515

6950 NE 14th St
Ste 36
Ankeny, IA 50023
Phone (515) 289-1515

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": "1430265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627603200000",
    "number": "1124405055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6950 NE 14TH ST STE 36",
            "city": "ANKENY",
            "state": "IA",
            "postal_code": "500238903",
            "telephone_number": "515-289-1515",
            "fax_number": "515-289-1511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6950 NE 14TH ST STE 36",
            "city": "ANKENY",
            "state": "IA",
            "postal_code": "500238903",
            "telephone_number": "515-289-1515",
            "fax_number": "515-289-1511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BIRCHWOOD WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-29",
        "last_updated": "2021-07-30",
        "certification_date": "2021-07-30",
        "status": "A",
        "authorized_official_last_name": "CAVES",
        "authorized_official_first_name": "MEGAN",
        "authorized_official_middle_name": "ELISE OTTO",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST",
        "authorized_official_telephone_number": "515-289-1515"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "364SP0808X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health",
            "state": "IA",
            "license": "G-108504",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IA",
            "license": "001268",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ankeny, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2021; 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.