NPIMap

Organization Active NPI

County of Outagamie

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Appleton, WI
National Provider Identifier
1629138995
Registry record updated May 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
COUNTY OF OUTAGAMIE
Practice address
320 S. Walnut St.
Appleton, WI 54911-5918
Phone
(920) 832-4741
Fax
(920) 832-5164
NPI assigned
Dec 9, 2006
Last updated
May 2, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 2, 2025

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

Authorized official

Name
John Rathman
Title
Interim Director HHS
Phone
(920) 832-5187

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X
Community/Behavioral Health Agency 251S00000X 1724 WI
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary
Multi-Specialty Clinic/Center 261QM1300X
Primary Care Clinic/Center 261QP2300X

Addresses

Primary practice location

320 S. Walnut St.
Appleton, WI 54911-5918

Mailing address

320 S. Walnut St.
Appleton, WI 54911-5918
Phone (920) 832-4741

Other identifiers 9

IdentifierTypeStateIssuer
44012800MedicaidWI
43426000MedicaidWI
41869100MedicaidWI
41761200MedicaidWI
43074500MedicaidWI
43106700MedicaidWI
10038416MedicaidWI
32978671MedicaidWI
42139100MedicaidWI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040813000471 WI Part B Supplier - Clinic/Group Practice 7517930019 Receives reassigned benefits from 23 practitioners
Practice locations: Appleton, WI

Other NPIs with the same Medicare PAC ID 1

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
52D2032940Outagamie County Jail320 S Walnut St, Appleton, WI 54911Certificate of waiverNov 17, 2027

National Provider Directory

National Provider Directory
Tax ID family
Hum Serv-Outagamie Co2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

401 S Elm St
Appleton, WI 54911
Phone (414) 832-5270

410 S Walnut St
Appleton, WI 54911
Phone (920) 832-4741

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Brewster VillageAppleton, WI, CCN 525574 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Mar 15, 2010

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 43

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 43

NPI Registry JSON

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

{
    "created_epoch": "1165622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746144000000",
    "number": "1629138995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 S. WALNUT ST.",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549115918",
            "telephone_number": "920-832-4741",
            "fax_number": "920-832-5164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 S. WALNUT ST.",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549115918",
            "telephone_number": "920-832-4741",
            "fax_number": "920-832-5164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF OUTAGAMIE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-09",
        "last_updated": "2025-05-02",
        "certification_date": "2025-05-02",
        "status": "A",
        "authorized_official_last_name": "RATHMAN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "INTERIM DIRECTOR HHS",
        "authorized_official_telephone_number": "920-832-5187"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "WI",
            "license": "1724",
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "44012800",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43426000",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41869100",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41761200",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43074500",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43106700",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10038416",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32978671",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42139100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.