NPIMap

Organization Active NPI

Mercyland Psychiatry Inc

Doing business as Mercyland Psychiatry

  • Child & Adolescent Psychiatry Physician
  • Sun Prairie, WI
National Provider Identifier
1194228114
Registry record updated May 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
60574-20 Issued in WI
Legal business name
MERCYLAND PSYCHIATRY INC
Doing business as
Mercyland Psychiatry
Practice address
530 W Main St
Sun Prairie, WI 53590-3219
Phone
(802) 399-9114
Fax
(608) 318-2789
NPI assigned
Mar 15, 2018
Last updated
May 7, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2018

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

Authorized official

Name
Dr. Adebowale Mofikoya, MDNPI 1275794422
Title
Medical Director
Phone
(802) 399-9114

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0804X 60574-20 WI Primary

Addresses

Primary practice location

530 W Main St
Sun Prairie, WI 53590-3219

Mailing address

530 W Main St
Sun Prairie, WI 53590-3219
Phone (802) 399-9114

Other names 1

  • Mercyland Psychiatry Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180508001446 WI Part B Supplier - Clinic/Group Practice 3274897897 Receives reassigned benefits from 4 practitioners
Practice locations: Sun Prairie, WI

National Provider Directory

National Provider Directory

Locations

425 W Main St
Ste 201
Sun Prairie, WI 53590
Phone (608) 318-2233

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/26294/brand/1/csg/1/fhir/r4

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": "1521072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525651200000",
    "number": "1194228114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 W MAIN ST",
            "city": "SUN PRAIRIE",
            "state": "WI",
            "postal_code": "535903219",
            "telephone_number": "802-399-9114",
            "fax_number": "608-318-2789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 W MAIN ST",
            "city": "SUN PRAIRIE",
            "state": "WI",
            "postal_code": "535903219",
            "telephone_number": "802-399-9114",
            "fax_number": "608-318-2789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCYLAND PSYCHIATRY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-15",
        "last_updated": "2018-05-07",
        "status": "A",
        "authorized_official_last_name": "MOFIKOYA",
        "authorized_official_first_name": "ADEBOWALE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "802-399-9114",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "WI",
            "license": "60574-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mercyland Psychiatry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sun Prairie, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2018; 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.