NPIMap

Organization Active NPI

QC Counselor PLC

  • Mental Health Counselor
  • Davenport, IA
National Provider Identifier
1285919977
Registry record updated Dec 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
00728 Issued in IA
Legal business name
QC COUNSELOR PLC
Practice address
2028 E 38TH St Ste 3
Davenport, IA 52807-1168
Phone
(563) 424-2016
Fax
(563) 424-2017
NPI assigned
Oct 13, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2023

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

Authorized official

Name
Matthew John MartensonNPI 1275088114
Title
Owner
Phone
(563) 424-2016

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
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X 00728 IA Primary

Addresses

Primary practice location

2028 E 38TH St Ste 3
Davenport, IA 52807-1168

Mailing address

2028 E 38TH St
Suite 3
Davenport, IA 52807-1168
Phone (563) 424-2016

Other identifiers 2

IdentifierTypeStateIssuer
11087500000MedicaidIA
1285919977MedicaidIA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240112000654 IA Part B Supplier - Clinic/Group Practice 9537510730 Receives reassigned benefits from 4 practitioners
Practice locations: Davenport, IA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1318464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703721600000",
    "number": "1285919977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2028 E 38TH ST",
            "address_2": "SUITE 3",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528071168",
            "telephone_number": "563-424-2016",
            "fax_number": "563-424-2017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2028 E 38TH ST STE 3",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528071168",
            "telephone_number": "563-424-2016",
            "fax_number": "563-424-2017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QC COUNSELOR PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-13",
        "last_updated": "2023-12-28",
        "certification_date": "2023-12-28",
        "status": "A",
        "authorized_official_last_name": "MARTENSON",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "563-424-2016"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "IA",
            "license": "00728",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11087500000",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1285919977",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Davenport, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2023; 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.