Bridgewater Behavioral Health, LLC

Primary specialty

PsychologistTaxonomy code 103T00000X

License

479 Issued in SD

Legal business name

BRIDGEWATER BEHAVIORAL HEALTH, LLC

Practice address

902 Columbus St
Rapid City, SD 57701-3543

Phone

(605) 791-1514

Fax

(844) 831-2349

NPI assigned

Jul 13, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Genni L Goschke, PSY.D.NPI 1679550065

Title

President

Phone

(605) 791-1514

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SD

Enrollment records 1

Practitioners 4

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

• Genni L. Goschke, PSY.D.

  • Psychologist
  • Rapid City, SD
  • NPI 1679550065
  Medicare reassignment Care Compare group NPD Authorized official
• Chantal Marie Peterson, PSY.D.

  • Clinical Psychologist
  • Hot Springs, SD
  • NPI 1427469519
  Medicare reassignment Care Compare group NPD
• Eric D. Traub, PSY.D.

  • Psychologist
  • Rapid City, SD
  • NPI 1356786917
  Medicare reassignment Care Compare group NPD
• Darlene Marie Wilcox, PH.D., LP

  • Clinical Psychologist
  • Rapid City, SD
  • NPI 1730412867
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1436745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436745600000",
    "number": "1588048201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1990",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577091990",
            "telephone_number": "605-791-1514",
            "fax_number": "844-831-2349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 COLUMBUS ST",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577013543",
            "telephone_number": "605-791-1514",
            "fax_number": "844-831-2349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGEWATER BEHAVIORAL HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-13",
        "last_updated": "2015-07-13",
        "status": "A",
        "authorized_official_last_name": "GOSCHKE",
        "authorized_official_first_name": "GENNI",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "605-791-1514",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "SD",
            "license": "479",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1679550065",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jodee Lynn Brewer, RN, BSN
• Karen J Brewer, MS, NCC, LPC
• Thomas Brey, ED.S.
• Brian G. Criss
• John L Bridges, DDS
• Rex Eric Briggs, MSW
• Douglas Alan Bright, MD
• Britton Eye Care PC
• Anne Britton, O.D.
• Patrick Britton, O.D

• Psychologist in Rapid City, SD
• Providers in Rapid City, SD by specialty
• Psychologist in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2015; 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.