NPIMap

Organization Active NPI

County of Brown

  • Psychiatric Hospital
  • Green Bay, WI
National Provider Identifier
1801908975
Registry record updated May 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
License
213 Issued in WI
Legal business name
COUNTY OF BROWN
Practice address
3150 Gershwin Drive
Green Bay, WI 54311-5859
Phone
(920) 391-4700
Fax
(920) 391-4870
NPI assigned
Aug 31, 2006
Organization subpart
Yes
Parent organization
COUNTY OF BROWNAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 10, 2024

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

Authorized official

Name
Kara Gruber
Title
Administrator
Phone
(920) 391-4700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X 213 WI Primary

Addresses

Primary practice location

3150 Gershwin Drive
Green Bay, WI 54311-5859

Mailing address

3150 Gershwin Drive
Green Bay, WI 54311-5859
Phone (920) 391-4700

Other identifiers 3

IdentifierTypeStateIssuer
CC6458OtherWIRAILROAD MEDICARE
510142673043OtherWIBLUE CROSS
10064500MedicaidWI

Other names 1

  • Brown County Community Treatment Center-Nicolet Psych Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100325000037 WI Part A Provider - Hospital 1355435900 Practice locations: Green Bay, WI
O20100524000844 WI Part B Supplier - Clinic/Group Practice 1355435900 Receives reassigned benefits from 22 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Green Bay, WI

Hospital certification: CCN 524014

Legal name
COUNTY OF BROWN
Doing business as
COMMUNITY TREATMENT CENTER
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Nov 5, 1969
Last certification
Apr 19, 2023
Beds
88
Ownership / control type
Local
Organization structure
GovernmentProprietary
Enrollment address
3150 Gershwin Dr
Green Bay, WI 54311-4328
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric, Psychiatric unit

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Brown County Community Treatment CtrCCN 524014
Type
Psychiatric
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory
Tax ID family
County of Brown19 organizations share this tax ID, including this one
Part of
County of Brown

Other organizations with this tax ID 18

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

View all 18

Locations

111 N Jefferson St
Green Bay, WI 54301
Phone (920) 448-4425

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
County of Brown Organization, Green Bay, WI Operational/Managerial Control Jan 1, 2010
Kara Gruber Individual Corporate DirectorHospital Administrator Jun 6, 2022
Operational/Managerial ControlHospital Administrator Jun 6, 2022
Erik J Pritzl Individual Corporate DirectorHumans Service Executive Directo Apr 1, 2015
Operational/Managerial ControlHuman Services Executive Directo Apr 1, 2015

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Brown County Community Treatment Center - Bayshore VillageGreen Bay, WI, CCN 525693 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Adp of the SNF		 Oct 10, 2009
Oct 10, 2009

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • County of Brown
    • Skilled Nursing Facility
    • Green Bay, WI
    • NPI 1033214150

    5% Or Greater Direct Ownership Interest, Adp of the SNF

    CMS ownership

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715299200000",
    "number": "1801908975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3150 GERSHWIN DRIVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543115859",
            "telephone_number": "920-391-4700",
            "fax_number": "920-391-4870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3150 GERSHWIN DRIVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543115859",
            "telephone_number": "920-391-4700",
            "fax_number": "920-391-4870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF BROWN",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COUNTY OF BROWN",
        "enumeration_date": "2006-08-31",
        "last_updated": "2024-05-10",
        "certification_date": "2024-05-10",
        "status": "A",
        "authorized_official_last_name": "GRUBER",
        "authorized_official_first_name": "KARA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "920-391-4700"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "WI",
            "license": "213",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CC6458",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "510142673043",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10064500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brown County Community Treatment Center-Nicolet Psych",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.