NPIMap

Organization Active NPI

Horizon Healthcare, Inc

  • Addiction (Substance Use Disorder) Counselor
  • Waukesha, WI
National Provider Identifier
1760408876
Registry record updated Sep 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
Legal business name
HORIZON HEALTHCARE, INC
Practice address
217 Wisconsin Ave
Suite 211
Waukesha, WI 53186-4946
Phone
(414) 306-6550
Fax
(414) 306-6550
NPI assigned
Jul 14, 2006
Last updated
Sep 30, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2013

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

Authorized official

Name
Darren Matavka
Title
Vice President
Phone
(414) 301-6383

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X
Addiction (Substance Use Disorder) Counselor 101YA0400X WI Primary
Mental Health Counselor 101YM0800X WI
Clinical Social Worker 1041C0700X WI

Addresses

Primary practice location

217 Wisconsin Ave
Suite 211
Waukesha, WI 53186-4946

Mailing address

285 N Janacek Rd
Brookfield, WI 53045-6102
Phone (414) 376-5577

Other identifiers 2

IdentifierTypeStateIssuer
42160621MedicaidWI
42160600MedicaidWI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040124000318 WI Part B Supplier - Clinic/Group Practice 0749182160 Receives reassigned benefits from 21 practitioners
18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Milwaukee, WI; Waukesha, WI; Racine, WI; Kenosha, WI

Other NPIs on the same Medicare enrollment 12

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

National Provider Directory

National Provider Directory

Locations

285 N Janacek Rd
Brookfield, WI 53045
Phone (262) 641-9050

217 Wisconsin Ave
Ste 211
Waukesha, WI 53186
Phone (262) 309-6243

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380499200000",
    "number": "1760408876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "285 N JANACEK RD",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530456102",
            "telephone_number": "414-376-5577",
            "fax_number": "414-376-5577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 WISCONSIN AVE",
            "address_2": "SUITE 211",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531864946",
            "telephone_number": "414-306-6550",
            "fax_number": "414-306-6550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HORIZON HEALTHCARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2013-09-30",
        "status": "A",
        "authorized_official_last_name": "MATAVKA",
        "authorized_official_first_name": "DARREN",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "414-301-6383"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": null,
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WI",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42160621",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42160600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukesha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2013; 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.