NPIMap

Organization Active NPI

Korsgaard Mental Health, Inc

  • Psychiatric/Mental Health Nurse Practitioner
  • Spokane, WA
National Provider Identifier
1245507664
Registry record updated Nov 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
AP30007598 Issued in WA
Legal business name
KORSGAARD MENTAL HEALTH, INC
Practice address
140 S 140 Arthur St
Ste 415
Spokane, WA 99202-2220
Phone
(509) 389-5794
Fax
(509) 533-0627
NPI assigned
Nov 30, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2016

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

Authorized official

Name
Mr. Christopher Patrick Korsgaard, ARNPNPI 1649316928
Title
Chairman of the Board
Phone
(509) 389-5794

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
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP0808X AP30007598 WA Primary

Addresses

Primary practice location

140 S 140 Arthur St
Ste 415
Spokane, WA 99202-2220

Mailing address

140 S Arthur St
Ste 670
Spokane, WA 99202-2204
Phone (509) 389-5794

Other identifiers 1

IdentifierTypeStateIssuer
20000528MedicaidWA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120320000226 WA Part B Supplier - Clinic/Group Practice 9032379680 Receives reassigned benefits from 1 practitioner
Practice locations: Spokane, WA

National Provider Directory

National Provider Directory

Locations

140 S Arthur St
Ste 670
Spokane, WA 99202
Phone (509) 242-6592

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1322611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480464000000",
    "number": "1245507664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 S ARTHUR ST",
            "address_2": "STE 670",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992022204",
            "telephone_number": "509-389-5794",
            "fax_number": "509-533-9627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 S 140 ARTHUR ST",
            "address_2": "STE 415",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992022220",
            "telephone_number": "509-389-5794",
            "fax_number": "509-533-0627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KORSGAARD MENTAL HEALTH, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-30",
        "last_updated": "2016-11-30",
        "status": "A",
        "authorized_official_last_name": "KORSGAARD",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "CHAIRMAN OF THE BOARD",
        "authorized_official_telephone_number": "509-389-5794",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP30007598",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20000528",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2016; 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.