NPIMap

Organization Active NPI

Bridgeway, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Galesburg, IL
National Provider Identifier
1154545879
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
BRIDGEWAY, INC
Practice address
1089 Hawkinson Ave
Galesburg, IL 61401-6900
Phone
(309) 343-2639
Fax
(309) 341-4770
NPI assigned
Apr 12, 2007
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
William Nelson
Title
Ceo
Phone
(309) 344-2323

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X IL Primary
Mental Illness Intermediate Care Facility 310500000X -031 IL

Addresses

Primary practice location

1089 Hawkinson Ave
Galesburg, IL 61401-6900

Mailing address

1089 Hawkinson Ave
Galesburg, IL 61401-6900
Phone (309) 343-2639

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050126000609 IL Part B Supplier - Clinic/Group Practice 4284627530 Receives reassigned benefits from 9 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Macomb, IL; Moline, IL; Monmouth, IL; Normal, IL; North Pekin, IL; Pekin, IL; Kewanee, IL; Loves Park, IL…

Other NPIs on the same Medicare enrollment 15

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

  • Bridgeway Inc
    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • Kewanee, IL
    • NPI 1114140621

    O20050126000609

    Same enrollment
  • Bridgeway Inc
    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • Monmouth, IL
    • NPI 1316160823

    O20050126000609

    Same enrollment
  • Bridgeway Inc
    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • Pekin, IL
    • NPI 1346524899

    O20050126000609

    Same enrollment
  • Bridgeway Inc
    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • Macomb, IL
    • NPI 1518185925

    O20050126000609

    Same enrollment
  • Bridgeway Inc
    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • Normal, IL
    • NPI 1588948046

    O20050126000609

    Same enrollment
  • Bridgeway Inc
    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • Galesburg, IL
    • NPI 1851315535

    O20050126000609

    Same enrollment
  • Bridgeway, Inc
    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • Kewanee, IL
    • NPI 1023231537

    O20050126000609

    Same enrollment
  • Bridgeway, Inc
    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • Galesburg, IL
    • NPI 1194948695

    O20050126000609

    Same enrollment
  • Bridgeway, Inc
    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • Galesburg, IL
    • NPI 1407079916

    O20050126000609

    Same enrollment
  • Bridgeway, Inc
    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • Kewanee, IL
    • NPI 1578788188

    O20050126000609

    Same enrollment
  • Bridgeway, Inc
    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • Galesburg, IL
    • NPI 1710100219

    O20050126000609

    Same enrollment
  • Bridgeway, Inc
    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • Macomb, IL
    • NPI 1760505044

    O20050126000609

    Same enrollment
View all 15

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

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": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1154545879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1089 HAWKINSON AVE",
            "city": "GALESBURG",
            "state": "IL",
            "postal_code": "614016900",
            "telephone_number": "309-343-2639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1089 HAWKINSON AVE",
            "city": "GALESBURG",
            "state": "IL",
            "postal_code": "614016900",
            "telephone_number": "309-343-2639",
            "fax_number": "309-341-4770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGEWAY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "309-344-2323"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "IL",
            "license": null,
            "primary": true
        },
        {
            "code": "310500000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Mental Illness",
            "state": "IL",
            "license": "-031",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Galesburg, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.