NPIMap

Organization Active NPI

Optum Behavioral Care of Virginia, Inc.

  • Counseling Psychologist
  • Mobile, AL
National Provider Identifier
1851164271
Registry record updated Jun 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Counseling PsychologistTaxonomy code 103TC1900X
Legal business name
OPTUM BEHAVIORAL CARE OF VIRGINIA, INC.
Practice address
1110 Montlimar Dr Ste 500
Mobile, AL 36609-1794
Phone
(251) 662-9466
Fax
(833) 449-5269
NPI assigned
Nov 7, 2023
Last updated
Jun 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2024

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

Authorized official

Name
Kerry Biscornet
Title
Secretary
Phone
(256) 325-2388

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counseling Psychologist 103TC1900X NU Primary

Addresses

Primary practice location

1110 Montlimar Dr Ste 500
Mobile, AL 36609-1794

Mailing address

11000 Optum Cir
Eden Prairie, MN 55344-2503
Phone (603) 854-2929

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240522003595 AL Part B Supplier - Clinic/Group Practice 3971945924 Receives reassigned benefits from 17 practitioners
1 other NPI on this enrollment
Practice locations: Huntsville, AL; Mobile, AL

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Optum Behavioral Care of VA9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1699315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719360000000",
    "number": "1851164271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11000 OPTUM CIR",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553442503",
            "telephone_number": "603-854-2929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 MONTLIMAR DR STE 500",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366091794",
            "telephone_number": "251-662-9466",
            "fax_number": "833-449-5269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTUM BEHAVIORAL CARE OF VIRGINIA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-07",
        "last_updated": "2024-06-26",
        "certification_date": "2024-06-26",
        "status": "A",
        "authorized_official_last_name": "BISCORNET",
        "authorized_official_first_name": "KERRY",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "256-325-2388"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mobile, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2024; 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.