NPIMap

Organization Active NPI

Waukesha County

  • Psychiatric Hospital
  • Waukesha, WI
National Provider Identifier
1407988892
Registry record updated Nov 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
License
524026 Issued in WI
Legal business name
WAUKESHA COUNTY
Practice address
1501 Airport Rd
Waukesha, WI 53188-3632
Phone
(262) 548-7950
Fax
(262) 896-8046
NPI assigned
Mar 12, 2007
Last updated
Nov 10, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2025

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

Authorized official

Name
David M Derosier
Title
Credentialing Specialist
Phone
(262) 548-8431

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X 524026 WI Primary

Addresses

Primary practice location

1501 Airport Rd
Waukesha, WI 53188-3632

Mailing address

514 Riverview Ave
Attn: Fiscal Department
Waukesha, WI 53188-3632
Phone (262) 548-7399

Other identifiers 2

IdentifierTypeStateIssuer
10063300OtherWVMA PROVIDER NUMBER
10063300MedicaidWI

Other names 1

  • Waukesha County (MHC Inpatient) Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040124000130 WI Part B Supplier - Clinic/Group Practice 3971405481 Receives reassigned benefits from 77 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Waukesha, WI
O20110131000666 WI Part A Provider - Hospital 3971405481 Practice locations: Waukesha, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1407988892. Details of each certification follow.

Hospital certification: CCN 524026

Legal name
WAUKESHA COUNTY
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Jun 5, 1979
Last certification
Sep 10, 2025
Beds
28
Ownership / control type
Local
Organization structure
GovernmentNon-profit
Enrollment address
1501 Airport Rd
Waukesha, WI 53188-2461
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Waukesha County Mental Health CtrCCN 524026 · All quality measures
Type
Psychiatric
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory
Tax ID family
Waukesha Co MH Ctr13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Randy Setzer Individual Operational/Managerial Control Jan 1, 2012
Waukesha County Organization, Waukesha, WI Operational/Managerial Control Jan 20, 2011
David M Derosier Individual Operational/Managerial ControlContracting Analyst Jan 1, 2023

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 34

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 34

NPI Registry JSON

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

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762732800000",
    "number": "1407988892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "514 RIVERVIEW AVE",
            "address_2": "ATTN: FISCAL DEPARTMENT",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531883632",
            "telephone_number": "262-548-7399",
            "fax_number": "262-970-6696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 AIRPORT RD",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531883632",
            "telephone_number": "262-548-7950",
            "fax_number": "262-896-8046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAUKESHA COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-12",
        "last_updated": "2025-11-10",
        "certification_date": "2025-11-10",
        "status": "A",
        "authorized_official_last_name": "DEROSIER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "262-548-8431"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "WI",
            "license": "524026",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MA PROVIDER NUMBER",
            "identifier": "10063300",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10063300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Waukesha County (MHC Inpatient)",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Waukesha County (MHC Inpatient)",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Waukesha, WI

Sources for this page

Verify at the official NPI Registry.