Active NPI
Bridgeway Inc
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Pekin, IL
National Provider Identifier
1346524899
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Legal business name
- BRIDGEWAY INC
- Practice address
- 2079 Edgewater Dr
Pekin, IL 61554 - Phone
- (309) 382-2006
- Fax
- (309) 382-2007
- NPI assigned
- Oct 3, 2011
- Last updated
- Jul 25, 2022
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- William Nelson
- Title
- Ceo
- Phone
- (309) 344-2323
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | Primary | ||
| Community/Behavioral Health Agency | 251S00000X | 04016 | IL |
Addresses
Primary practice location
2079 Edgewater Dr
Pekin, IL 61554
Mailing address
2079 Edgewater Dr
Pekin, IL 61554-7833
Phone (309) 382-2006
Other practice location 1
2079 Edgewater Dr
Pekin, IL 61554
Phone (309) 382-2006
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04016 | Medicaid | IL | |
| AC 217/557-9285 | Other | IL | MEDICARE CERTIFICATION |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050126000609 | IL | Part B Supplier - Clinic/Group Practice | 4284627530 |
Receives reassigned benefits from 9 practitioners 15 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Macomb, IL; Moline, IL; Monmouth, IL; Normal, IL; North Pekin, IL; Pekin, IL; Kewanee, IL; Loves Park, IL… |
Other NPIs on the same Medicare enrollment 15
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Kewanee, IL
- NPI 1114140621
O20050126000609
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Monmouth, IL
- NPI 1316160823
O20050126000609
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Macomb, IL
- NPI 1518185925
O20050126000609
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Normal, IL
- NPI 1588948046
O20050126000609
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Galesburg, IL
- NPI 1851315535
O20050126000609
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Kewanee, IL
- NPI 1023231537
O20050126000609
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Galesburg, IL
- NPI 1154545879
O20050126000609
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Galesburg, IL
- NPI 1194948695
O20050126000609
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Galesburg, IL
- NPI 1407079916
O20050126000609
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Kewanee, IL
- NPI 1578788188
O20050126000609
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Galesburg, IL
- NPI 1710100219
O20050126000609
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Macomb, IL
- NPI 1760505044
O20050126000609
National Provider Directory
National Provider DirectoryLocations
2079 Edgewater Dr
Pekin, IL 61554
Phone (309) 382-2006
Practitioners & affiliated clinicians
Practitioners 11
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.
-
- Adult Psychiatric/Mental Health Registered Nurse
- Pekin, IL
- NPI 1598244915
-
- Case Management Registered Nurse
- Pekin, IL
- NPI 1376769638
-
- Psychiatry Physician
- Mundelein, IL
- NPI 1548311194
-
- Registered Nurse
- Pekin, IL
- NPI 1558838409
-
- Psychiatry Physician
- Chicago, IL
- NPI 1033206800
-
- Psychiatry Physician
- Galesburg, IL
- NPI 1952402901
-
- Psychiatric/Mental Health Registered Nurse
- North Pekin, IL
- NPI 1417285842
-
- Psychiatry Physician
- Rockford, IL
- NPI 1578551370
-
- Psychiatry Physician
- Hibbing, MN
- NPI 1598985517
-
- Psychiatry Physician
- Hannibal, MO
- NPI 1164447322
-
- Psychiatry Physician
- Tahlequah, OK
- NPI 1083659635
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317600000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1658707200000",
"number": "1346524899",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2079 EDGEWATER DR",
"city": "PEKIN",
"state": "IL",
"postal_code": "615547833",
"telephone_number": "309-382-2006",
"fax_number": "309-382-2007"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2079 EDGEWATER DR",
"city": "PEKIN",
"state": "IL",
"postal_code": "61554",
"telephone_number": "309-382-2006",
"fax_number": "309-382-2007"
}
],
"practiceLocations": [
{
"address_1": "2079 Edgewater Dr",
"address_purpose": "LOCATION",
"city": "Pekin",
"state": "IL",
"postal_code": "61554",
"country_code": "US",
"telephone_number": "309-382-2006",
"fax_number": "309-382-2007",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "BRIDGEWAY INC",
"organizational_subpart": "NO",
"enumeration_date": "2011-10-03",
"last_updated": "2022-07-25",
"certification_date": "2022-07-25",
"status": "A",
"authorized_official_last_name": "NELSON",
"authorized_official_first_name": "WILLIAM",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "309-344-2323"
},
"taxonomies": [
{
"code": "261QM0801X",
"taxonomy_group": "",
"desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
"state": null,
"license": null,
"primary": true
},
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": "IL",
"license": "04016",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "04016",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE CERTIFICATION",
"identifier": "AC 217/557-9285",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pekin, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2022; 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.