NPIMap

Organization Active NPI

Madison County

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Wampsville, NY
National Provider Identifier
1689780546
Registry record updated Dec 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
6873100A Issued in NY
Legal business name
MADISON COUNTY
Practice address
138 North Court Street
Wampsville, NY 13163-0608
Phone
(315) 366-2327
Fax
(315) 366-2599
NPI assigned
Aug 22, 2006
Last updated
Dec 6, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2019

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

Authorized official

Name
Mrs. Teisha M Cook, LCSW-RNPI 1447443437
Title
Director
Phone
(315) 366-2327

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 6873100A NY Primary

Addresses

Primary practice location

138 North Court Street
Wampsville, NY 13163-0608

Mailing address

138 North Court Street
Wampsville, NY 13163-0608
Phone (315) 366-2327

Other identifiers 2

IdentifierTypeStateIssuer
00569860MedicaidNY
03004400MedicaidNY

Other names 1

  • Madison County Mental Health Department Outpatient Clinic Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040206000289 NY Part B Supplier - Clinic/Group Practice 2365335957 Receives reassigned benefits from 18 practitioners
Practice locations: Wampsville, NY

Other NPIs with the same Medicare PAC ID 1

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

  • Madison County

    dba Madison County Department of Health

    • Public Health or Welfare Agency
    • Wampsville, NY
    • NPI 1487796975

    2365335957

    Same PAC ID

National Provider Directory

National Provider Directory
Tax ID family
Madison County10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

138 N Court St
Wampsville, NY 13163
Phone (315) 366-2788

138 N Court St
#5
Wampsville, NY 13163
Phone (315) 366-2361

138 N Court St
#B
Wampsville, NY 13163

138 N Court St
Fl 2
Wampsville, NY 13163

Practitioners & affiliated clinicians

Practitioners 58

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 58

NPI Registry JSON

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

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1575590400000",
    "number": "1689780546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "138 NORTH COURT STREET",
            "city": "WAMPSVILLE",
            "state": "NY",
            "postal_code": "131630608",
            "telephone_number": "315-366-2327",
            "fax_number": "315-366-2599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "138 NORTH COURT STREET",
            "city": "WAMPSVILLE",
            "state": "NY",
            "postal_code": "131630608",
            "telephone_number": "315-366-2327",
            "fax_number": "315-366-2599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADISON COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-22",
        "last_updated": "2019-12-06",
        "status": "A",
        "authorized_official_last_name": "COOK",
        "authorized_official_first_name": "TEISHA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "315-366-2327",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW-R"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NY",
            "license": "6873100A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00569860",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03004400",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Madison County Mental Health Department Outpatient Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Madison County Mental Health Department Outpatient Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Wampsville, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2019; 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.