NPIMap

Organization Active NPI

Camp-Grimit Petersen LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Bennington, NE
National Provider Identifier
1922532324
Registry record updated Apr 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
111672 Issued in NE
Legal business name
CAMP-GRIMIT PETERSEN LLC
Practice address
12077 Elmwood Dr
Bennington, NE 68007-1716
Phone
(402) 332-7648
NPI assigned
Apr 12, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2017

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

Authorized official

Name
Molly Petersen, APRNNPI 1679987432
Title
Co-Owner
Phone
(402) 332-7648

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 111672 NE Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 110773 NE

Addresses

Primary practice location

12077 Elmwood Dr
Bennington, NE 68007-1716

Mailing address

12077 Elmwood Dr
Bennington, NE 68007-1716
Phone (402) 332-7648

Other names 1

  • Collaborative Psych Practitioners Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170630000084 NE Part B Supplier - Clinic/Group Practice 2264701598 Receives reassigned benefits from 6 practitioners
Practice locations: Bellevue, NE; Omaha, NE

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

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": "1491955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491955200000",
    "number": "1922532324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12077 ELMWOOD DR",
            "city": "BENNINGTON",
            "state": "NE",
            "postal_code": "680071716",
            "telephone_number": "402-332-7648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12077 ELMWOOD DR",
            "city": "BENNINGTON",
            "state": "NE",
            "postal_code": "680071716",
            "telephone_number": "402-332-7648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMP-GRIMIT PETERSEN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-12",
        "last_updated": "2017-04-12",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "MOLLY",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "402-332-7648",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NE",
            "license": "111672",
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NE",
            "license": "110773",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Collaborative Psych Practitioners",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bennington, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2017; 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.