NPIMap

Organization Active NPI

Community Care of Portage County

  • Exclusive Provider Organization
  • Stevens Point, WI
National Provider Identifier
1295853059
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Exclusive Provider OrganizationTaxonomy code 302F00000X
Legal business name
COMMUNITY CARE OF PORTAGE COUNTY
Practice address
817 Whiting Ave
Stevens Point, WI 54481-5246
Phone
(715) 345-5968
Fax
(715) 345-5725
NPI assigned
Mar 27, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
James Canales
Title
Director
Phone
(715) 345-5800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Exclusive Provider Organization 302F00000X Primary

Addresses

Primary practice location

817 Whiting Ave
Stevens Point, WI 54481-5246

Mailing address

817 Whiting Ave
Stevens Point, WI 54481-5246
Phone (715) 345-5968

Other identifiers 1

IdentifierTypeStateIssuer
69005700MedicaidWI

National Provider Directory

National Provider Directory
Tax ID family
Portage Co Human Serv3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1295853059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "817 WHITING AVE",
            "city": "STEVENS POINT",
            "state": "WI",
            "postal_code": "544815246",
            "telephone_number": "715-345-5968",
            "fax_number": "715-345-5725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "817 WHITING AVE",
            "city": "STEVENS POINT",
            "state": "WI",
            "postal_code": "544815246",
            "telephone_number": "715-345-5968",
            "fax_number": "715-345-5725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY CARE OF PORTAGE COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CANALES",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "715-345-5800"
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "69005700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stevens Point, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.