NPIMap

Organization Active NPI

County of Waushara

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Wautoma, WI
National Provider Identifier
1932207362
Registry record updated Nov 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
COUNTY OF WAUSHARA
Practice address
380 S Townline Rd
Wautoma, WI 54982-6900
Phone
(207) 876-5509
NPI assigned
Sep 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2024

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

Authorized official

Name
Jen Gonzales
Title
Account Clerk
Phone
(920) 787-6550

Specialties & licenses 1

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

Addresses

Primary practice location

380 S Townline Rd
Wautoma, WI 54982-6900

Mailing address

380 S Townline Rd
Wautoma, WI 54982-6900
Phone (920) 787-6550

Other identifiers 1

IdentifierTypeStateIssuer
42140600MedicaidWI

Other names 2

  • Waushara County Clinical Services Doing business as
  • Waushara County Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040121001042 WI Part B Supplier - Clinic/Group Practice 9638071681 Receives reassigned benefits from 9 practitioners
Practice locations: Wautoma, WI

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Waushara Co Clinical SV12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Locations

380 S Townline Rd
Wautoma, WI 54982
Phone (920) 787-6550

Practitioners & affiliated clinicians

Practitioners 11

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": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730937600000",
    "number": "1932207362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "380 S TOWNLINE RD",
            "city": "WAUTOMA",
            "state": "WI",
            "postal_code": "549826900",
            "telephone_number": "920-787-6550",
            "fax_number": "920-787-0421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 S TOWNLINE RD",
            "city": "WAUTOMA",
            "state": "WI",
            "postal_code": "549826900",
            "telephone_number": "207-876-5509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF WAUSHARA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2024-11-07",
        "certification_date": "2024-11-07",
        "status": "A",
        "authorized_official_last_name": "GONZALES",
        "authorized_official_first_name": "JEN",
        "authorized_official_title_or_position": "ACCOUNT CLERK",
        "authorized_official_telephone_number": "920-787-6550"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42140600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Waushara County Clinical Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Waushara County",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Wautoma, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 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.