NPIMap

Organization Active NPI

Tellurian, Inc.

  • Psychiatry Physician
  • Madison, WI
National Provider Identifier
1164432118
Registry record updated Aug 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
TELLURIAN, INC.
Practice address
1053 Williamson St
Madison, WI 53703-3525
Phone
(608) 258-3446
Fax
(608) 258-3445
NPI assigned
Aug 9, 2006
Last updated
Aug 15, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
TELLURIAN, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 15, 2022

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

Authorized official

Name
Erica L Mueller
Title
Quality Assurance Director
Phone
(608) 204-8547

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X NU Primary
Addiction Psychiatry Physician 2084P0802X NU

Addresses

Primary practice location

1053 Williamson St
Madison, WI 53703-3525

Mailing address

1053 Williamson St
Madison, WI 53703-3525
Phone (608) 258-3446

Other names 1

  • Mental Health Clinic Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071128000134 WI Part B Supplier - Clinic/Group Practice 6204925365 Receives reassigned benefits from 12 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Monona, WI; Madison, WI

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
Tellurian Inc10 organizations share this tax ID, including this one
Part of
Tellurian Inc

Other organizations with this tax ID 9

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

Locations

1053 Williamson St
Madison, WI 53703
Phone (608) 258-3446

Practitioners & affiliated clinicians

Practitioners 4

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": "1155081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660521600000",
    "number": "1164432118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1053 WILLIAMSON ST",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537033525",
            "telephone_number": "608-258-3446",
            "fax_number": "608-258-3445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1053 WILLIAMSON ST",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537033525",
            "telephone_number": "608-258-3446",
            "fax_number": "608-258-3445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TELLURIAN, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TELLURIAN, INC.",
        "enumeration_date": "2006-08-09",
        "last_updated": "2022-08-15",
        "certification_date": "2021-01-05",
        "status": "A",
        "authorized_official_last_name": "MUELLER",
        "authorized_official_first_name": "ERICA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "QUALITY ASSURANCE DIRECTOR",
        "authorized_official_telephone_number": "608-204-8547"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0802X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mental Health Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Mental Health Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Madison, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 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.