Mercy Health System Corporation
Organization Active NPI Mental Health Clinic/Center (Including Community Mental Health Center) · Janesville, WI
NPI 1669685129 · NPPES record last updated Jun 11, 2025
Key facts
- NPI
- 1669685129
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
- License
- 310800 (WI)
- Legal business name
- MERCY HEALTH SYSTEM CORPORATION
- Practice address
- 903 Mineral Point Ave
Janesville, WI 53548-2970 - Phone
- (608) 756-5555
- Fax
- (608) 756-0174
- NPI assigned
- May 8, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- MERCY HEALTH CORPORATION
Authorized official
- Name
- Joseph D Malas
- Title
- Cfo Authorized Official
- Phone
- (815) 971-6738
Other NPIs on the same Medicare enrollment 2
Corporate family (same tax ID) 15
Practitioners 49
-
William E Ayetey, M.D.
-
Sharon A. Barger, PH.D., LCSW LPC SAC
-
Victoria L Baumel, LCSW
-
Heather J. Beck, LCSW, SAC, APSW
-
Teresa Bingham, LCSW
-
Allyson Jade Brissette, LCSW
-
Cristin M Burkeland, LCSW, APSW
-
Stacy M. Condon, LCSW
-
Deborah A. Dubanowich, SAC, LPC-IT
-
Eliza S Godfrey, PHD
-
Jodie Nicole Hoekman, LPC, SAC-IT
-
Debra Lynn Johnson, LCSW
-
Sobia Kirmani Moe, M.D.
-
Tina L. Kosnar, MD
-
Tiffany N. Kroll Garcia, LCSW, SAC
-
Sharada K Lange, LPC, CSAC
-
Jackie S Legler, LPC, SAC
-
Angela M Levin, SLP
-
Bret J. Loescher, PSY.D., LPC, SAC
-
Krystal Lucas, LCSW, MSW, CAPSW
-
Jocelyn Marie Mallon, LPC
-
Benjamin C. Miller, PMHNP
-
Briann N. Modos, APRN, PMHNP-BC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031113000164 | WI | Part B Supplier - Clinic/Group Practice | 7416860440 |
Receives reassigned benefits from 1,195 practitioners 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Genesis Counseling SVC
Locations
903 Mineral Point Ave
Janesville, WI 53548
Phone (608) 756-5555
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | 310-800 | WI | |
| Adult Day Care Clinic/Center | 261QA0600X | 310-800 | WI | |
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | 310800 | WI | Yes |
| Adolescent and Children Mental Health Clinic/Center | 261QM0855X | 310-800 | WI | |
| Rehabilitation Clinic/Center | 261QR0400X | 310-800 | WI |
Addresses
Primary practice location
903 Mineral Point Ave
Janesville, WI 53548-2970
Mailing address
1000 Mineral Point Ave
Janesville, WI 53548
Phone (608) 756-6000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 42180300 | Medicaid | WI | |
| 42180321 | Medicaid | WI | |
| 42180200 | Medicaid | WI | |
| 42232800 | Medicaid | WI | |
| 43171321 | Medicaid | WI | |
| 42180221 | Medicaid | WI | |
| 11011426 | Medicaid | WI | |
| 43009200 | Medicaid | WI |
Other names
- Mercy Options Behavioral Health
Other providers in Janesville, WI
- Mercy Health System Corporation
- Mercy Health System Corporation
- Mercy Health System Corporation
- Mercy Health System Corporation
- Mercy Health System Corporation
- Mercy Health System Corporation
- Mercycare HMO, Inc
- Mercycare Insurance Company
- Steven J Merema
- Krysta Merich
All providers in Janesville, WI · Mental Health Clinic/Center (Including Community Mental Health Center) in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 11, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.