NPIMap

Organization Active NPI

Berrien Mental Health Authority

  • Psychiatry Physician
  • Saint Joseph, MI
National Provider Identifier
1508801465
Registry record updated Sep 7, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
BERRIEN MENTAL HEALTH AUTHORITY
Practice address
2500 Niles Rd Ste 7
Saint Joseph, MI 49085-3268
Phone
(269) 982-7844
Fax
(269) 982-1783
NPI assigned
Jun 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2010

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

Authorized official

Name
Mr. Allen R Edlefson
Title
Ceo
Phone
(269) 934-1611

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YM0800X
Clinical PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC0700X
Psychiatry PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

2500 Niles Rd Ste 7
Saint Joseph, MI 49085-3268

Mailing address

2500 Niles Rd Ste 7
Saint Joseph, MI 49085-3268
Phone (269) 982-7844

Other identifiers 1

IdentifierTypeStateIssuer
750910476OtherMIBCBS PIN #

Other names 1

  • NorthStar Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050124000376 MI Part B Supplier - Clinic/Group Practice 0345223707 Receives reassigned benefits from 28 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Benton Harbor, MI; Niles, MI; Saint Joseph, MI

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory

Locations

333 N 2nd St
Ste 302
Niles, MI 49120
Phone (269) 687-1714

309 N 5th St
Niles, MI 49120
Phone (269) 684-4270

3950 Hollywood Rd
Ste 245
Saint Joseph, MI 49085
Phone (269) 982-7844

2920 Division St
Saint Joseph, MI 49085
Phone (269) 982-7844

Practitioners & affiliated clinicians

Practitioners 33

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

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283817600000",
    "number": "1508801465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 NILES RD STE 7",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490853268",
            "telephone_number": "269-982-7844",
            "fax_number": "269-982-1783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 NILES RD STE 7",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490853268",
            "telephone_number": "269-982-7844",
            "fax_number": "269-982-1783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BERRIEN MENTAL HEALTH AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-17",
        "last_updated": "2010-09-07",
        "status": "A",
        "authorized_official_last_name": "EDLEFSON",
        "authorized_official_first_name": "ALLEN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "269-934-1611",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PIN #",
            "identifier": "750910476",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NorthStar Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Joseph, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2010; 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.