James K Dercks, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

6749 Issued in WI

Practice address

1810 Appleton Rd
Menasha, WI 54952-1110

Phone

(920) 739-4226

Fax

(920) 739-7639

NPI assigned

Jan 27, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Family Services of Northeast Wisconsin IncGroup PAC ID 7214832229, 10 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Family Services of Northeast Wisconsin Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Menasha, WI
  • NPI 1275525925
  Medicare reassignment Care Compare group NPD
• Family Services of Northeast Wisconsin Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Green Bay, WI
  • NPI 1467453167
  NPD

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

{
    "created_epoch": "1453852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513036800000",
    "number": "1134586779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1810 APPLETON RD",
            "city": "MENASHA",
            "state": "WI",
            "postal_code": "549521110",
            "telephone_number": "920-739-4226",
            "fax_number": "920-739-7639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1810 APPLETON RD",
            "city": "MENASHA",
            "state": "WI",
            "postal_code": "549521110",
            "telephone_number": "920-739-4226",
            "fax_number": "920-739-7639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERCKS",
        "first_name": "JAMES",
        "middle_name": "K",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-01-27",
        "last_updated": "2017-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "6749",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Greg A Delaney, CSAC
• Heather A Delforge, PHARMD
• Michelle Lynn Delorey, M.S.E. L.P.C. N.C.C.
• Depas Family Dental Care, S. C.
• Nicole Marie Deprez
• Judith Margaret Doersch, L.C.S.W.
• Debra Marie Dominczak, LPC IT
• Gretchen Dominowski, LPC-IT, SAC-IT
• Lawrence R Donatelle, MD
• Brittany Dorn, PT

• Professional Counselor in Menasha, WI
• Providers in Menasha, WI by specialty
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.