NPIMap

Organization Active NPI

Petersburg Mental Health Services, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Petersburg, AK
National Provider Identifier
1174690309
Registry record updated Jul 22, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
282463 Issued in AK
Legal business name
PETERSBURG MENTAL HEALTH SERVICES, INC.
Practice address
201 North Nordic Drive
Petersburg, AK 99833-1309
Phone
(907) 772-3332
Fax
(888) 858-8850
NPI assigned
Nov 30, 2006
Last updated
Jul 22, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2010

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

Authorized official

Name
Susan Ohmer, LCSWNPI 1295995942
Title
Director
Phone
(907) 772-3332

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X 282463 AK
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 282463 AK
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 282463 AK Primary

Addresses

Primary practice location

201 North Nordic Drive
Petersburg, AK 99833-1309

Mailing address

PO Box 1309
Petersburg, AK 99833-1309
Phone (907) 772-3332

Other identifiers 2

IdentifierTypeStateIssuer
DA1413MedicaidAK
MH1413MedicaidAK

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/raincountry/r4/

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": "1164844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279756800000",
    "number": "1174690309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1309",
            "city": "PETERSBURG",
            "state": "AK",
            "postal_code": "998331309",
            "telephone_number": "907-772-3332",
            "fax_number": "888-858-8850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 NORTH NORDIC DRIVE",
            "city": "PETERSBURG",
            "state": "AK",
            "postal_code": "998331309",
            "telephone_number": "907-772-3332",
            "fax_number": "888-858-8850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSBURG MENTAL HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-30",
        "last_updated": "2010-07-22",
        "status": "A",
        "authorized_official_last_name": "OHMER",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "907-772-3332",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "AK",
            "license": "282463",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "AK",
            "license": "282463",
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "AK",
            "license": "282463",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DA1413",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MH1413",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Petersburg, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.