NPIMap

Organization Active NPI

Mending Minds, LLC

Doing business as Walnut Creek Psychiatry

  • Psychiatric/Mental Health Nurse Practitioner
  • Johnston, IA
National Provider Identifier
1245833565
Registry record updated Aug 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
MENDING MINDS, LLC
Doing business as
Walnut Creek Psychiatry
Practice address
5408 NW 88TH St Ste 140
Johnston, IA 50131-2953
Phone
(515) 368-7504
Fax
(515) 355-3491
NPI assigned
Nov 19, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2024

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

Authorized official

Name
Hillary Chidester
Title
Office Manager
Phone
(515) 368-7504

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

5408 NW 88TH St Ste 140
Johnston, IA 50131-2953

Mailing address

5408 NW 88TH St Ste 140
Johnston, IA 50131-2953
Phone (515) 368-7504

Other practice location 1

515 Pacific Ave
Audubon, IA 50025-1056
Phone (515) 368-7504

Other practice location 2

223 S Walnut Ave
Ames, IA 50010-6974
Phone (515) 368-7504

Other practice location 3

710 N 12th St
Guthrie Center, IA 50115-1536
Phone (515) 368-7504

Other names 1

  • Walnut Creek Psychiatry Doing business as

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address info@walnutcreekpsych.com
CONNECT URL https://spruce.care/walnutcreekpsychjohnston Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210104000116 IA Part B Supplier - Clinic/Group Practice 5496168882 Receives reassigned benefits from 15 practitioners
Practice locations: Guthrie Center, IA; Johnston, IA; Audubon, IA; Ames, IA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D2287808Walnut Creek Psychiatry5408 NW 88TH St #140, Johnston, IA 50131Certificate of waiverAug 16, 2027

National Provider Directory

National Provider Directory

Locations

223 S Walnut Ave
Ames, IA 50010
Phone (515) 233-1122

5408 NW 88th St
Ste 140
Johnston, IA 50131
Phone (515) 368-7504

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1605744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723593600000",
    "number": "1245833565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5408 NW 88TH ST STE 140",
            "city": "JOHNSTON",
            "state": "IA",
            "postal_code": "501312953",
            "telephone_number": "515-368-7504",
            "fax_number": "515-355-3491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5408 NW 88TH ST STE 140",
            "city": "JOHNSTON",
            "state": "IA",
            "postal_code": "501312953",
            "telephone_number": "515-368-7504",
            "fax_number": "515-355-3491"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "515 Pacific Ave",
            "address_purpose": "LOCATION",
            "city": "Audubon",
            "state": "IA",
            "postal_code": "500251056",
            "country_code": "US",
            "telephone_number": "515-368-7504",
            "fax_number": "515-355-3491",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "223 S Walnut Ave",
            "address_purpose": "LOCATION",
            "city": "Ames",
            "state": "IA",
            "postal_code": "500106974",
            "country_code": "US",
            "telephone_number": "515-368-7504",
            "fax_number": "515-355-3491",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "710 N 12th St",
            "address_purpose": "LOCATION",
            "city": "Guthrie Center",
            "state": "IA",
            "postal_code": "501151536",
            "country_code": "US",
            "telephone_number": "515-368-7504",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MENDING MINDS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-19",
        "last_updated": "2024-08-14",
        "certification_date": "2024-08-14",
        "status": "A",
        "authorized_official_last_name": "CHIDESTER",
        "authorized_official_first_name": "HILLARY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "515-368-7504"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@walnutcreekpsych.com",
            "affiliation": "N",
            "address_1": "5408 NW 88th St Ste 140",
            "city": "Johnston",
            "state": "IA",
            "country_code": "US",
            "postal_code": "501312953",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://spruce.care/walnutcreekpsychjohnston",
            "affiliation": "N",
            "endpointDescription": "Spruce Secure Message",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Spruce Secure Communications",
            "address_1": "5408 NW 88th St Ste 140",
            "city": "Johnston",
            "state": "IA",
            "country_code": "US",
            "postal_code": "501312953",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Walnut Creek Psychiatry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Johnston, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.