NPIMap

Organization Active NPI

Agnesian Healthcare

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Beaver Dam, WI
National Provider Identifier
1700817657
Registry record updated Sep 4, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
1753 Issued in WI
Legal business name
AGNESIAN HEALTHCARE
Practice address
200 Front St
Suite 3D
Beaver Dam, WI 53916-1667
Phone
(920) 885-2780
Fax
(920) 885-2788
NPI assigned
Jul 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2007

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

Authorized official

Name
Dr. James Salasek, PHD
Title
Clinic Director
Phone
(920) 885-2780

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 1753 WI Primary

Addresses

Primary practice location

200 Front St
Suite 3D
Beaver Dam, WI 53916-1667

Mailing address

200 Front St
Suite 3D
Beaver Dam, WI 53916-1667
Phone (920) 885-2780

Other names 1

  • Psychiatric Associates Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031104000263 WI Part B Supplier - Clinic/Group Practice 1658289624 Receives reassigned benefits from 630 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory

Locations

200 Front St
Ste 3D
Beaver Dam, WI 53916
Phone (920) 885-2780

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188864000000",
    "number": "1700817657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 FRONT ST",
            "address_2": "SUITE 3D",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539161667",
            "telephone_number": "920-885-2780",
            "fax_number": "920-885-2788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 FRONT ST",
            "address_2": "SUITE 3D",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539161667",
            "telephone_number": "920-885-2780",
            "fax_number": "920-885-2788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGNESIAN HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2007-09-04",
        "status": "A",
        "authorized_official_last_name": "SALASEK",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "920-885-2780",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "WI",
            "license": "1753",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Psychiatric Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Beaver Dam, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2007; 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.