NPIMap

Organization Active NPI

Tellurian, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Monona, WI
National Provider Identifier
1235302480
Registry record updated Aug 15, 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
TELLURIAN, INC.
Practice address
300 Femrite Dr
Monona, WI 53716-3716
Phone
(608) 222-7311
Fax
(608) 222-5904
NPI assigned
Apr 9, 2008
Organization subpart
No

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
Kelly E Crooks, MSW
Title
Quality Assurance Manager
Phone
(608) 663-2120

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 774 WI
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

300 Femrite Dr
Monona, WI 53716-3716

Mailing address

300 Femrite Dr
Monona, WI 53716-3716
Phone (608) 222-7311

Other identifiers 1

IdentifierTypeStateIssuer
39394400MedicaidWI

Other names 2

  • Tellurian UCAN Inc. Former legal business name
  • Tellurian Outpatient 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

Other organizations with this tax ID 9

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

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1207699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660521600000",
    "number": "1235302480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 FEMRITE DR",
            "city": "MONONA",
            "state": "WI",
            "postal_code": "537163716",
            "telephone_number": "608-222-7311",
            "fax_number": "608-222-5904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 FEMRITE DR",
            "city": "MONONA",
            "state": "WI",
            "postal_code": "537163716",
            "telephone_number": "608-222-7311",
            "fax_number": "608-222-5904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TELLURIAN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-09",
        "last_updated": "2022-08-15",
        "certification_date": "2021-01-05",
        "status": "A",
        "authorized_official_last_name": "CROOKS",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "QUALITY ASSURANCE MANAGER",
        "authorized_official_telephone_number": "608-663-2120",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "WI",
            "license": "774",
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39394400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tellurian UCAN Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Tellurian Outpatient Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Monona, 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.