NPIMap

Organization Active NPI

Bridgeway Inc

  • Community/Behavioral Health Agency
  • Macomb, IL
National Provider Identifier
1861776213
Registry record updated Nov 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
04016 Issued in IL
Legal business name
BRIDGEWAY INC
Practice address
590 S Deer Rd
Macomb, IL 61455-2604
Phone
(309) 837-4876
Fax
(309) 833-1531
NPI assigned
Oct 4, 2011
Last updated
Nov 30, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2011

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

Authorized official

Name
Staci Danner
Title
Billing Manager
Phone
(309) 344-2323

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X 04016 IL
Mental Health Counselor 101YM0800X 04016 IL
Professional Counselor 101YP2500X 04016 IL
Social Worker 104100000X 04016 IL
Community/Behavioral Health Agency 251S00000X 04016 IL Primary

Addresses

Primary practice location

590 S Deer Rd
Macomb, IL 61455-2604

Mailing address

590 S Deer Rd
Macomb, IL 61455-2639
Phone (309) 836-9910

Other identifiers 1

IdentifierTypeStateIssuer
04016OtherILMENTAL HEALTH MEDICAID CERTIFICATE

National Provider Directory

National Provider Directory
Tax ID family
Julio R Lozano MD15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1317686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322611200000",
    "number": "1861776213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "590 S DEER RD",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "614552639",
            "telephone_number": "309-836-9910",
            "fax_number": "309-836-3422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "590 S DEER RD",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "614552604",
            "telephone_number": "309-837-4876",
            "fax_number": "309-833-1531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGEWAY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-04",
        "last_updated": "2011-11-30",
        "status": "A",
        "authorized_official_last_name": "DANNER",
        "authorized_official_first_name": "STACI",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "309-344-2323"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "IL",
            "license": "04016",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "04016",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "04016",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IL",
            "license": "04016",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "IL",
            "license": "04016",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MENTAL HEALTH MEDICAID CERTIFICATE",
            "identifier": "04016",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Macomb, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2011; 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.