NPIMap

Organization Active NPI

Family Services of Northeast Wisconsin Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Menasha, WI
National Provider Identifier
1275525925
Registry record updated Jun 4, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
1333 Issued in WI
Legal business name
FAMILY SERVICES OF NORTHEAST WISCONSIN INC
Practice address
1810 Appleton Rd
Menasha, WI 54952-1110
Phone
(920) 739-4226
Fax
(920) 739-7639
NPI assigned
Aug 18, 2005
Last updated
Jun 4, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2009

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

Authorized official

Name
Mr. Thomas E Martin, LCSW
Title
President / Ceo
Phone
(920) 436-6800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 1333 WI Primary

Addresses

Primary practice location

1810 Appleton Rd
Menasha, WI 54952-1110

Mailing address

1810 Appleton Rd
Menasha, WI 54952-1110
Phone (920) 739-4226

Other identifiers 1

IdentifierTypeStateIssuer
42222600MedicaidWI

Other names 1

  • Family Services of NEW Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031203000498 WI Part B Supplier - Clinic/Group Practice 7214832229 Receives reassigned benefits from 16 practitioners
1 other NPI on this enrollment
Practice locations: Green Bay, WI; Menasha, WI

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Family Serv Northeast W10 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 119

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 119

NPI Registry JSON

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

{
    "created_epoch": "1124323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1244073600000",
    "number": "1275525925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1810 APPLETON RD",
            "city": "MENASHA",
            "state": "WI",
            "postal_code": "549521110",
            "telephone_number": "920-739-4226",
            "fax_number": "920-739-7639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1810 APPLETON RD",
            "city": "MENASHA",
            "state": "WI",
            "postal_code": "549521110",
            "telephone_number": "920-739-4226",
            "fax_number": "920-739-7639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY SERVICES OF NORTHEAST WISCONSIN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-18",
        "last_updated": "2009-06-04",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT / CEO",
        "authorized_official_telephone_number": "920-436-6800",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "WI",
            "license": "1333",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42222600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Services of NEW",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Menasha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2009; 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.