NPIMap

Organization Active NPI

Jefferson County

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Jefferson, WI
National Provider Identifier
1275614919
Registry record updated Sep 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
1449 Issued in WI
Legal business name
JEFFERSON COUNTY
Practice address
1541 Annex Rd
Jefferson, WI 53549
Phone
(920) 674-3105
Fax
(920) 674-6113
NPI assigned
Oct 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2024

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

Authorized official

Name
Brian Bellford, CPA
Title
Deputy Director
Phone
(920) 674-8147

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 1449 WI Primary

Addresses

Primary practice location

1541 Annex Rd
Jefferson, WI 53549

Mailing address

1541 Annex Rd
Jefferson, WI 53549
Phone (920) 674-3105

Other identifiers 1

IdentifierTypeStateIssuer
42138100MedicaidWI

Other names 1

  • Jefferson County Human Service Dept-Mental Health Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041115000371 WI Part B Supplier - Clinic/Group Practice 2264496801 Receives reassigned benefits from 26 practitioners
1 other NPI on this enrollment
Practice locations: Jefferson, WI

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

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

  • Jefferson County

    dba Jefferson County Human Services

    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • Jefferson, WI
    • NPI 1578562286

    O20041115000371

    Same enrollment

National Provider Directory

National Provider Directory
Tax ID family
Jefferson County12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Practitioners & affiliated clinicians

Practitioners 27

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 27

NPI Registry JSON

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726099200000",
    "number": "1275614919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1541 ANNEX RD",
            "city": "JEFFERSON",
            "state": "WI",
            "postal_code": "53549",
            "telephone_number": "920-674-3105",
            "fax_number": "920-674-6113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1541 ANNEX RD",
            "city": "JEFFERSON",
            "state": "WI",
            "postal_code": "53549",
            "telephone_number": "920-674-3105",
            "fax_number": "920-674-6113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2024-09-12",
        "certification_date": "2024-09-12",
        "status": "A",
        "authorized_official_last_name": "BELLFORD",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "DEPUTY DIRECTOR",
        "authorized_official_telephone_number": "920-674-8147",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "WI",
            "license": "1449",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42138100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jefferson County Human Service Dept-Mental Health",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Jefferson, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2024; 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.