Active NPI
Bridgeway, Inc
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Galesburg, IL
National Provider Identifier
1710100219
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Legal business name
- BRIDGEWAY, INC
- Practice address
- 1235 W Carl Sandburg Dr
Galesburg, IL 61401-7014 - Phone
- (309) 344-6207
- Fax
- (309) 344-7678
- NPI assigned
- Apr 11, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- William Nelson
- Title
- Ceo
- Phone
- (309) 344-2323
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | Primary | ||
| Mental Illness Intermediate Care Facility | 310500000X | 026 | IL |
Addresses
Primary practice location
1235 W Carl Sandburg Dr
Galesburg, IL 61401-7014
Mailing address
2323 Windish Dr
Galesburg, IL 61401-9780
Phone (309) 344-2323
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050126000609 | IL | Part B Supplier - Clinic/Group Practice | 4284627530 |
Receives reassigned benefits from 9 practitioners 15 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Macomb, IL; Moline, IL; Monmouth, IL; Normal, IL; North Pekin, IL; Pekin, IL; Kewanee, IL; Loves Park, IL… |
Other NPIs on the same Medicare enrollment 15
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Kewanee, IL
- NPI 1114140621
O20050126000609
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Monmouth, IL
- NPI 1316160823
O20050126000609
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Pekin, IL
- NPI 1346524899
O20050126000609
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Macomb, IL
- NPI 1518185925
O20050126000609
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Normal, IL
- NPI 1588948046
O20050126000609
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Galesburg, IL
- NPI 1851315535
O20050126000609
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Kewanee, IL
- NPI 1023231537
O20050126000609
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Galesburg, IL
- NPI 1154545879
O20050126000609
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Galesburg, IL
- NPI 1194948695
O20050126000609
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Galesburg, IL
- NPI 1407079916
O20050126000609
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Kewanee, IL
- NPI 1578788188
O20050126000609
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Macomb, IL
- NPI 1760505044
O20050126000609
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176249600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1658361600000",
"number": "1710100219",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2323 WINDISH DR",
"city": "GALESBURG",
"state": "IL",
"postal_code": "614019780",
"telephone_number": "309-344-2323"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1235 W CARL SANDBURG DR",
"city": "GALESBURG",
"state": "IL",
"postal_code": "614017014",
"telephone_number": "309-344-6207",
"fax_number": "309-344-7678"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BRIDGEWAY, INC",
"organizational_subpart": "NO",
"enumeration_date": "2007-04-11",
"last_updated": "2022-07-21",
"status": "A",
"authorized_official_last_name": "NELSON",
"authorized_official_first_name": "WILLIAM",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "309-344-2323"
},
"taxonomies": [
{
"code": "261QM0801X",
"taxonomy_group": "",
"desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
"state": null,
"license": null,
"primary": true
},
{
"code": "310500000X",
"taxonomy_group": "",
"desc": "Intermediate Care Facility, Mental Illness",
"state": "IL",
"license": "026",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Galesburg, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.