NPIMap

Individual provider Active NPI

Mark J. Renner, MS. LMHP, CPC, LIMHP

  • Mental Health Counselor
  • Fremont, NE
National Provider Identifier
1609950211
Registry record updated Apr 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
677 Issued in NE
Practice address
748 N Main St
Fremont, NE 68025-5004
Phone
(402) 941-7016
Fax
(402) 941-7018
NPI assigned
Oct 24, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 20, 2011

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X 2401 NE
Counselor 101Y00000X 1320 NE
Mental Health Counselor 101YM0800X 677 NE Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X 677 NE

Addresses

Primary practice location

748 N Main St
Fremont, NE 68025-5004

Mailing address

748 N Main St
Fremont, NE 68025-5004
Phone (402) 941-7016

Other identifiers 2

IdentifierTypeStateIssuer
10025122100MedicaidNE
10025816100OtherNEMEDICAID SA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
1320NEMDCounselor
2401NEMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Associated Counseling Group Mental Health Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1303257600000",
    "number": "1609950211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "748 N MAIN ST",
            "city": "FREMONT",
            "state": "NE",
            "postal_code": "680255004",
            "telephone_number": "402-941-7016",
            "fax_number": "402-941-7018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "748 N MAIN ST",
            "city": "FREMONT",
            "state": "NE",
            "postal_code": "680255004",
            "telephone_number": "402-941-7016",
            "fax_number": "402-941-7018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RENNER",
        "first_name": "MARK",
        "middle_name": "J.",
        "name_prefix": "Mr.",
        "credential": "MS. LMHP, CPC, LIMHP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-24",
        "last_updated": "2011-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NE",
            "license": "2401",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NE",
            "license": "1320",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NE",
            "license": "677",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NE",
            "license": "677",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025122100",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID SA",
            "identifier": "10025816100",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fremont, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.