NPIMap

Organization Active NPI

Chautauqua Clinic

  • Psychiatry Physician
  • Fairfield, IA
National Provider Identifier
1841569936
Registry record updated Jun 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
23126 Issued in IA
Legal business name
CHAUTAUQUA CLINIC
Practice address
2709 W Briggs Ave Ste 4
Fairfield, IA 52556-2649
Phone
(641) 472-7216
Fax
(641) 209-6690
NPI assigned
Dec 20, 2011
Last updated
Jun 7, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2016

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

Authorized official

Name
Dr. Russell Duane England, M.D.NPI 1932212917
Title
Medical Doctor Psychiatry
Phone
(641) 472-7216

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 23126 IA Primary

Addresses

Primary practice location

2709 W Briggs Ave Ste 4
Fairfield, IA 52556-2649

Mailing address

2709 W Briggs Ave Ste 4
Fairfield, IA 52556-2649
Phone (641) 472-7216

Other identifiers 1

IdentifierTypeStateIssuer
0056978MedicaidIA

National Provider Directory

National Provider Directory

Locations

204 W Burlington Ave
Ste B
Fairfield, IA 52556
Phone (641) 472-7216

Practitioners & affiliated clinicians

Practitioners 3

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": "1324339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465257600000",
    "number": "1841569936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2709 W BRIGGS AVE STE 4",
            "city": "FAIRFIELD",
            "state": "IA",
            "postal_code": "525562649",
            "telephone_number": "641-472-7216",
            "fax_number": "641-209-6690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2709 W BRIGGS AVE STE 4",
            "city": "FAIRFIELD",
            "state": "IA",
            "postal_code": "525562649",
            "telephone_number": "641-472-7216",
            "fax_number": "641-209-6690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHAUTAUQUA CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-20",
        "last_updated": "2016-06-07",
        "status": "A",
        "authorized_official_last_name": "ENGLAND",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "DUANE",
        "authorized_official_title_or_position": "MEDICAL DOCTOR PSYCHIATRY",
        "authorized_official_telephone_number": "641-472-7216",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IA",
            "license": "23126",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0056978",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfield, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.