NPIMap

Organization Active NPI

Tioga County

Doing business as Tioga County Alcohol and Drug Services

  • Addiction (Substance Use Disorder) Counselor
  • Owego, NY
National Provider Identifier
1205031499
Registry record updated Jan 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
071011080 Issued in NY
Legal business name
TIOGA COUNTY
Doing business as
Tioga County Alcohol and Drug Services
Practice address
1062 State Route 38
Owego, NY 13827
Phone
(607) 687-0200
Fax
(607) 687-0248
NPI assigned
Jun 18, 2007
Last updated
Jan 30, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
TIOGA COUNTYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 30, 2012

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

Authorized official

Name
Sue Romanczuk-Smelcer, PH.D, LCSW-R
Title
Director of Community Services
Phone
(607) 687-0200

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X NU
Addiction (Substance Use Disorder) Counselor 101YA0400X 071011080 NY Primary
Clinical Social Worker 1041C0700X NU
Addiction Psychiatry Physician 2084P0802X NU

Addresses

Primary practice location

1062 State Route 38
Owego, NY 13827

Mailing address

1062 State Route 38
PO Box 177
Owego, NY 13827
Phone (607) 687-0200

Other identifiers 2

IdentifierTypeStateIssuer
00618162MedicaidNY
071011080OtherNYNYS OASAS OPER. CERT. NO.

Other names 1

  • Tioga County Alcohol and Drug Services Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040113000343 NY Part B Supplier - Clinic/Group Practice 6709786916 Receives reassigned benefits from 15 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Owego, NY; Waverly, NY

Other NPIs on the same Medicare enrollment 2

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

  • Tioga County

    dba Tioga County Department of Mental Hygiene

    • Case Management Agency
    • Owego, NY
    • NPI 1114122306

    O20040113000343

    Same enrollment
  • Tioga County

    dba Tioga County Department of Mental Hygiene

    • Clinical Social Worker
    • Owego, NY
    • NPI 1124099700

    O20040113000343

    Same enrollment

National Provider Directory

National Provider Directory
Tax ID family
Tioga Cnty Dgnstc Trtmn13 organizations share this tax ID, including this one
Part of
Tioga Cnty Dgnstc Trtmn

Other organizations with this tax ID 12

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

Practitioners & affiliated clinicians

Practitioners 8

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": "1182124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327881600000",
    "number": "1205031499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1062 STATE ROUTE 38",
            "address_2": "PO BOX 177",
            "city": "OWEGO",
            "state": "NY",
            "postal_code": "13827",
            "telephone_number": "607-687-0200",
            "fax_number": "607-687-0248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1062 STATE ROUTE 38",
            "city": "OWEGO",
            "state": "NY",
            "postal_code": "13827",
            "telephone_number": "607-687-0200",
            "fax_number": "607-687-0248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIOGA COUNTY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TIOGA COUNTY",
        "enumeration_date": "2007-06-18",
        "last_updated": "2012-01-30",
        "status": "A",
        "authorized_official_last_name": "ROMANCZUK-SMELCER",
        "authorized_official_first_name": "SUE",
        "authorized_official_title_or_position": "DIRECTOR OF COMMUNITY SERVICES",
        "authorized_official_telephone_number": "607-687-0200",
        "authorized_official_credential": "PH.D, LCSW-R"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NY",
            "license": "071011080",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0802X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00618162",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NYS OASAS OPER. CERT. NO.",
            "identifier": "071011080",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tioga County Alcohol and Drug Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Owego, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2012; 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.