NPIMap

Organization Active NPI

Ven Healthcare Council Bluffs LLC

  • Psychiatry Physician
  • Council Bluffs, IA
National Provider Identifier
1306526116
Registry record updated Jul 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
VEN HEALTHCARE COUNCIL BLUFFS LLC
Practice address
29 S Main St
Council Bluffs, IA 51503-9070
Phone
(712) 524-1888
NPI assigned
Jul 18, 2023
Last updated
Jul 18, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2023

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

Authorized official

Name
Vithyalakshmi Selvaraj, MDNPI 1801006325
Title
Owner
Phone
(712) 524-1888

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
Psychiatry Physician 2084P0800X Primary

Addresses

Primary practice location

29 S Main St
Council Bluffs, IA 51503-9070

Mailing address

29 S Main St
Council Bluffs, IA 51503-9070
Phone (712) 524-1888

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240119002762 IA Part B Supplier - Clinic/Group Practice 5496107955 Receives reassigned benefits from 8 practitioners
Practice locations: Council Bluffs, IA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1689638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689638400000",
    "number": "1306526116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29 S MAIN ST",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515039070",
            "telephone_number": "712-524-1888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29 S MAIN ST",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515039070",
            "telephone_number": "712-524-1888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VEN HEALTHCARE COUNCIL BLUFFS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-18",
        "last_updated": "2023-07-18",
        "certification_date": "2023-07-18",
        "status": "A",
        "authorized_official_last_name": "SELVARAJ",
        "authorized_official_first_name": "VITHYALAKSHMI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "712-524-1888",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Council Bluffs, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 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.