Active NPI
Ian Roudebush
- Professional Counselor
- Brown Deer, WI
National Provider Identifier
1710606520
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- Practice address
- 3900 W Brown Deer Rd Ste 200
Brown Deer, WI 53209-1220 - Phone
- (414) 540-2170
- NPI assigned
- Aug 24, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | Primary |
Addresses
Primary practice location
3900 W Brown Deer Rd Ste 200
Brown Deer, WI 53209-1220
Mailing address
3900 W Brown Deer Rd Ste 200
Brown Deer, WI 53209-1220
Phone (414) 540-2170
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 2022
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
3900 W Brown Deer Rd
Suite 200
Brown Deer, WI 53209-1220
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shorehaven Behavioral Health Inc | Professional | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Child & Adolescent Psychiatry Physician
- Milwaukee, WI
- NPI 1598800740
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1661299200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661299200000",
"number": "1710606520",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3900 W BROWN DEER RD STE 200",
"city": "BROWN DEER",
"state": "WI",
"postal_code": "532091220",
"telephone_number": "414-540-2170"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3900 W BROWN DEER RD STE 200",
"city": "BROWN DEER",
"state": "WI",
"postal_code": "532091220",
"telephone_number": "414-540-2170"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROUDEBUSH",
"first_name": "IAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-08-24",
"last_updated": "2022-08-24",
"certification_date": "2022-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brown Deer, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.