NPIMap

Organization Active NPI

Kalamazoo County Community Mental Health Authority

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Kalamazoo, MI
National Provider Identifier
1710066253
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
SA0390177 Issued in MI
Legal business name
KALAMAZOO COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
Practice address
615 E Crosstown Pkwy
Kalamazoo, MI 49001-2501
Phone
(269) 553-7000
Fax
(269) 553-8012
NPI assigned
Nov 3, 2006
Last updated
Mar 17, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Authorized official

Name
Mrs. Pat Davis
Title
Deputy Director
Phone
(269) 553-8017

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X SA0390177 MI Primary

Addresses

Primary practice location

615 E Crosstown Pkwy
Kalamazoo, MI 49001-2501

Mailing address

2030 Portage St
Kalamazoo, MI 49001-3836
Phone (269) 553-7000

Other practice location 1

418 W Kalamazoo Ave
Kalamazoo, MI 49007-3334
Phone (269) 373-6000

Other identifiers 1

IdentifierTypeStateIssuer
4352736MedicaidMI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050624000176 MI Part B Supplier - Clinic/Group Practice 5890730337 Receives reassigned benefits from 75 practitioners
1 other NPI on this enrollment
Practice locations: Kalamazoo, MI

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Locations

418 W Kalamazoo Ave
Kalamazoo, MI 49007
Phone (269) 373-6000

Practitioners & affiliated clinicians

Practitioners 84

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 84

NPI Registry JSON

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1710066253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2030 PORTAGE ST",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490013836",
            "telephone_number": "269-553-7000",
            "fax_number": "269-553-8012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 E CROSSTOWN PKWY",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490012501",
            "telephone_number": "269-553-7000",
            "fax_number": "269-553-8012"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "418 W Kalamazoo Ave",
            "address_purpose": "LOCATION",
            "city": "Kalamazoo",
            "state": "MI",
            "postal_code": "490073334",
            "country_code": "US",
            "telephone_number": "269-373-6000",
            "fax_number": "269-373-4951",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KALAMAZOO COUNTY COMMUNITY MENTAL HEALTH AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-03",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "PAT",
        "authorized_official_title_or_position": "DEPUTY DIRECTOR",
        "authorized_official_telephone_number": "269-553-8017",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "MI",
            "license": "SA0390177",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4352736",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.