NPIMap

Organization Active NPI

The Josselyn Center NFP

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Waukegan, IL
National Provider Identifier
1649806407
Registry record updated Mar 12, 2020
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
THE JOSSELYN CENTER NFP
Practice address
415 Washington St Ste 200
Waukegan, IL 60085-5564
Phone
(847) 441-5600
Fax
(847) 441-7968
NPI assigned
Mar 12, 2020
Last updated
Mar 12, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
THE JOSSELYN CENTER NFPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 12, 2020

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

Authorized official

Name
Kenneth G. Wiersum
Title
VP of Finance
Phone
(847) 441-5603

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

415 Washington St Ste 200
Waukegan, IL 60085-5564

Mailing address

405 Central Ave
Northfield, IL 60093-3006
Phone (847) 441-5600

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050525000069 IL Part B Supplier - Clinic/Group Practice 0840289740 Receives reassigned benefits from 144 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Northbrook, IL; Waukegan, IL; Northfield, IL; Grayslake, IL

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Tax ID family
The Josselyn Center NFP13 organizations share this tax ID, including this one
Part of
The Josselyn Center NFP

Other organizations with this tax ID 12

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

Locations

415 Washington St
Ste 200
Waukegan, IL 60085
Phone (224) 290-1259

Practitioners & affiliated clinicians

Practitioners 59

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 59

NPI Registry JSON

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

{
    "created_epoch": "1583971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583971200000",
    "number": "1649806407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 CENTRAL AVE",
            "city": "NORTHFIELD",
            "state": "IL",
            "postal_code": "600933006",
            "telephone_number": "847-441-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 WASHINGTON ST STE 200",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600855564",
            "telephone_number": "847-441-5600",
            "fax_number": "847-441-7968"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE JOSSELYN CENTER NFP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE JOSSELYN CENTER NFP",
        "enumeration_date": "2020-03-12",
        "last_updated": "2020-03-12",
        "certification_date": "2020-03-12",
        "status": "A",
        "authorized_official_last_name": "WIERSUM",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "847-441-5603"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukegan, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2020; 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.