NPIMap

Organization Active NPI

Waukesha County

  • Community/Behavioral Health Agency
  • Waukesha, WI
National Provider Identifier
1780716175
Registry record updated Nov 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
43422400 Issued in WI
Legal business name
WAUKESHA COUNTY
Practice address
1501 Airport Rd
Waukesha, WI 53188-3632
Phone
(262) 548-7950
Fax
(262) 970-4791
NPI assigned
Mar 12, 2007
Last updated
Nov 10, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2025

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

Authorized official

Name
David M Derosier
Title
Credentialing Specialist
Phone
(262) 896-8431

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 43422400 WI Primary

Addresses

Primary practice location

1501 Airport Rd
Waukesha, WI 53188-3632

Mailing address

514 Riverview Ave
Waukesha, WI 53188-3631
Phone (262) 548-7399

Other identifiers 2

IdentifierTypeStateIssuer
43422400OtherWIMA PROVIDER NUMBER
43422400MedicaidWI

Other names 1

  • Waukesha County (CSP) Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040124000130 WI Part B Supplier - Clinic/Group Practice 3971405481 Receives reassigned benefits from 77 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Waukesha, WI

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory
Tax ID family
Waukesha Co MH Ctr13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Locations

514 Riverview Ave
Waukesha, WI 53188
Phone (262) 548-7212

Practitioners & affiliated clinicians

Practitioners 6

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": "1173657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762732800000",
    "number": "1780716175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "514 RIVERVIEW AVE",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531883631",
            "telephone_number": "262-548-7399",
            "fax_number": "262-970-6696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 AIRPORT RD",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531883632",
            "telephone_number": "262-548-7950",
            "fax_number": "262-970-4791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAUKESHA COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-12",
        "last_updated": "2025-11-10",
        "certification_date": "2025-11-10",
        "status": "A",
        "authorized_official_last_name": "DEROSIER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "262-896-8431"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "WI",
            "license": "43422400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MA PROVIDER NUMBER",
            "identifier": "43422400",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43422400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Waukesha County (CSP)",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Nov 10, 2025; 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.