NPIMap

Organization Active NPI

County of Green Lake

Doing business as Green Lake County DHHS

  • Professional Counselor
  • Green Lake, WI
National Provider Identifier
1780867408
Registry record updated Jul 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
COUNTY OF GREEN LAKE
Doing business as
Green Lake County DHHS
Practice address
571 County Road a
Green Lake, WI 54941
Phone
(920) 294-4070
Fax
(920) 294-4139
NPI assigned
Dec 17, 2007
Last updated
Jul 3, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2018

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

Authorized official

Name
Mr. Jason N. Jerome
Title
Director
Phone
(920) 294-4070

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X Primary

Addresses

Primary practice location

571 County Road a
Green Lake, WI 54941

Mailing address

571 County Road a
Green Lake, WI 54941-8630
Phone (920) 294-4070

Other identifiers 1

IdentifierTypeStateIssuer
42139800MedicaidWI

Other names 1

  • Green Lake County DHHS Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20051011001149 WI Part B Supplier - Clinic/Group Practice 6507881265 Receives reassigned benefits from 6 practitioners
Practice locations: Green Lake, WI
O20110707000381 WI Part B Supplier - Mass Immunization (Roster Biller Only) 6507881265 Practice locations: Green Lake, WI

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Green Lake County DHHS3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

571 County Road A
Green Lake, WI 54941
Phone (920) 294-4070

Practitioners & affiliated clinicians

Practitioners 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1197849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530576000000",
    "number": "1780867408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "571 COUNTY ROAD A",
            "city": "GREEN LAKE",
            "state": "WI",
            "postal_code": "549418630",
            "telephone_number": "920-294-4070",
            "fax_number": "920-294-4139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "571 COUNTY ROAD A",
            "city": "GREEN LAKE",
            "state": "WI",
            "postal_code": "54941",
            "telephone_number": "920-294-4070",
            "fax_number": "920-294-4139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF GREEN LAKE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-17",
        "last_updated": "2018-07-03",
        "status": "A",
        "authorized_official_last_name": "JEROME",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "920-294-4070",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42139800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Green Lake County DHHS",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Green Lake County DHHS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Green Lake, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 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.