NPIMap

Organization Active NPI

Community Mental Health Services of St Joseph County

  • Community/Behavioral Health Agency
  • Centreville, MI
National Provider Identifier
1366438483
Registry record updated May 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
COMMUNITY MENTAL HEALTH SERVICES OF ST JOSEPH COUNTY
Practice address
677 E Main St Ste a
Centreville, MI 49032-8525
Phone
(269) 467-1000
Fax
(269) 467-3075
NPI assigned
Sep 23, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 31, 2023

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

Authorized official

Name
Cameron Bullock, MBA
Title
Ceo
Phone
(269) 467-1001

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

677 E Main St Ste a
Centreville, MI 49032-8525

Mailing address

677 E Main St Ste a
Centreville, MI 49032-8525
Phone (269) 467-1000

Other identifiers 1

IdentifierTypeStateIssuer
1708146MedicaidMI

Other names 2

  • Community Mental Health and Substance Abuse Services of St Joseph Coun Doing business as
  • Pivotal Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041011000172 MI Part B Supplier - Clinic/Group Practice 9032178496 Receives reassigned benefits from 39 practitioners
Practice locations: Three Rivers, MI; Sturgis, MI; Centreville, MI

National Provider Directory

National Provider Directory
Tax ID family
Comm MNT HLTH Ser of St2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

677 E Main St
Ste A
Centreville, MI 49032
Phone (269) 467-1001

677 E Main St
Centreville, MI 49032
Phone (269) 467-1001

210 S Main St
Three Rivers, MI 49093
Phone (269) 273-5000

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 61

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

View all 61

NPI Registry JSON

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

{
    "created_epoch": "1127433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685491200000",
    "number": "1366438483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "677 E MAIN ST STE A",
            "city": "CENTREVILLE",
            "state": "MI",
            "postal_code": "490328525",
            "telephone_number": "269-467-1000",
            "fax_number": "269-467-3075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "677 E MAIN ST STE A",
            "city": "CENTREVILLE",
            "state": "MI",
            "postal_code": "490328525",
            "telephone_number": "269-467-1000",
            "fax_number": "269-467-3075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY MENTAL HEALTH SERVICES OF ST JOSEPH COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-23",
        "last_updated": "2023-05-31",
        "certification_date": "2023-05-31",
        "status": "A",
        "authorized_official_last_name": "BULLOCK",
        "authorized_official_first_name": "CAMERON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "269-467-1001",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1708146",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Mental Health and Substance Abuse Services of St Joseph Coun",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Community Mental Health and Substance Abuse Services of St Joseph Coun",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pivotal",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Centreville, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 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.