NPIMap

Organization Active NPI

Waubonsie Mental Health Center Inc

  • Community/Behavioral Health Agency
  • Clarinda, IA
National Provider Identifier
1376698837
Registry record updated Feb 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
WAUBONSIE MENTAL HEALTH CENTER INC
Practice address
216 W Division St
Clarinda, IA 51632-2509
Phone
(712) 542-2388
Fax
(712) 542-2984
NPI assigned
Jan 24, 2007
Last updated
Feb 6, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2019

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

Authorized official

Name
Brian Shotwell
Title
Executive Director
Phone
(712) 542-2388

Specialties & licenses 1

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

Addresses

Primary practice location

216 W Division St
Clarinda, IA 51632-2509

Mailing address

216 W Division St
Clarinda, IA 51632-2509
Phone (712) 542-2388

Other identifiers 3

IdentifierTypeStateIssuer
0299446MedicaidIA
0017244MedicaidIA
0229419MedicaidIA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040322001214 IA Part B Supplier - Clinic/Group Practice 1658262415 Receives reassigned benefits from 12 practitioners
Practice locations: Clarinda, IA; Red Oak, IA; Shenandoah, IA

National Provider Directory

National Provider Directory

Locations

1800 N 16th St
Ste 1
Clarinda, IA 51632
Phone (712) 438-4030

216 W Division St
Clarinda, IA 51632
Phone (712) 542-5676

1000 N Broadway St
#A2
Red Oak, IA 51566

1000 N Broadway St
Ste A
Red Oak, IA 51566

1213 5th Ave
Shenandoah, IA 51601
Phone 71254223882001

300 Park Ave
Ste A
Shenandoah, IA 51601

600 S Fremont St
Ste 3
Shenandoah, IA 51601

Practitioners & affiliated clinicians

Practitioners 25

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 25

NPI Registry JSON

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549411200000",
    "number": "1376698837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "216 W DIVISION ST",
            "city": "CLARINDA",
            "state": "IA",
            "postal_code": "516322509",
            "telephone_number": "712-542-2388",
            "fax_number": "712-542-2984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 W DIVISION ST",
            "city": "CLARINDA",
            "state": "IA",
            "postal_code": "516322509",
            "telephone_number": "712-542-2388",
            "fax_number": "712-542-2984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAUBONSIE MENTAL HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-24",
        "last_updated": "2019-02-06",
        "status": "A",
        "authorized_official_last_name": "SHOTWELL",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "712-542-2388"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "IA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0299446",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0017244",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0229419",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarinda, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2019; 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.