NPIMap

Organization Active NPI

County of Brown

Doing business as Brown County Community Treatment Center - MD Group

  • Psychiatry Physician
  • Green Bay, WI
National Provider Identifier
1679747059
Registry record updated May 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
COUNTY OF BROWN
Doing business as
Brown County Community Treatment Center - MD Group
Practice address
3150 Gershwin Drive
Green Bay, WI 54311-5859
Phone
(920) 391-4700
Fax
(920) 391-4870
NPI assigned
Apr 17, 2008
Last updated
May 10, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
COUNTY OF BROWNAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 10, 2024

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

Authorized official

Name
Kara Gruber
Title
Administrator
Phone
(920) 391-4700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X NU Primary

Addresses

Primary practice location

3150 Gershwin Drive
Green Bay, WI 54311-5859

Mailing address

3150 Gershwin Drive
Green Bay, WI 54311-5859
Phone (920) 391-4700

Other identifiers 1

IdentifierTypeStateIssuer
32795400MedicaidWI

Other names 1

  • BROWN COUNTY COMMUNITY TREATMENT CENTER - MD GROUP Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100524000844 WI Part B Supplier - Clinic/Group Practice 1355435900 Receives reassigned benefits from 22 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Green Bay, WI

Other NPIs on the same Medicare enrollment 2

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

  • County of Brown

    dba Brown County Community Treatment Center-Nicolet Psych

    • Psychiatric Hospital
    • Green Bay, WI
    • NPI 1801908975

    O20100524000844

    Same enrollment
  • County of Brown

    dba Brown County Community Treatment Center - Clinic

    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • Green Bay, WI
    • NPI 1942305065

    O20100524000844

    Same enrollment

National Provider Directory

National Provider Directory
Tax ID family
Brown Co HLTH Dept19 organizations share this tax ID, including this one
Part of
Brown Co HLTH Dept

Other organizations with this tax ID 18

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

View all 18

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1208390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715299200000",
    "number": "1679747059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3150 GERSHWIN DRIVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543115859",
            "telephone_number": "920-391-4700",
            "fax_number": "920-391-4870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3150 GERSHWIN DRIVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543115859",
            "telephone_number": "920-391-4700",
            "fax_number": "920-391-4870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF BROWN",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COUNTY OF BROWN",
        "enumeration_date": "2008-04-17",
        "last_updated": "2024-05-10",
        "certification_date": "2024-05-10",
        "status": "A",
        "authorized_official_last_name": "GRUBER",
        "authorized_official_first_name": "KARA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "920-391-4700"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32795400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BROWN COUNTY COMMUNITY TREATMENT CENTER - MD GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2024; 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.