NPIMap

Organization Active NPI

County of Brown

Doing business as Brown County Community Treatment Center - Clinic

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Green Bay, WI
National Provider Identifier
1942305065
Registry record updated May 10, 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 BROWN
Doing business as
Brown County Community Treatment Center - Clinic
Practice address
3150 Gershwin Drive
Green Bay, WI 54311-5859
Phone
(920) 391-6940
Fax
(920) 391-4870
NPI assigned
Sep 13, 2006
Last updated
May 10, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
COUNTY OF BROWNAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 10, 2024

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

Authorized official

Name
Eliza Killian
Title
Behavioral Health Supervisor
Phone
(920) 391-4700

Specialties & licenses 1

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

Addresses

Primary practice location

3150 Gershwin Drive
Green Bay, WI 54311-5859

Mailing address

3150 Gershwin Drive
Green Bay, WI 54311-5859
Phone (920) 391-4839

Other identifiers 3

IdentifierTypeStateIssuer
510142673068OtherWIBLUE CROSS
42186400MedicaidWI
CC6458OtherWIRAILROAD MEDICARE

Other names 1

  • Brown County Community Treatment Center - Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100524000844 WI Part B Supplier - Clinic/Group Practice 1355435900 Receives reassigned benefits from 22 practitioners
2 other NPIs on this enrollment
Practice locations: Green Bay, WI

Other NPIs with the same Medicare PAC ID 2

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

  • County of Brown

    dba Brown County Community Treatment Center-Bayshore Village

    • Skilled Nursing Facility
    • Green Bay, WI
    • NPI 1033214150

    1355435900

    Same PAC ID
  • County of Brown

    dba Brown County Community Treatment Center-Nicolet Psych

    • Psychiatric Hospital
    • Green Bay, WI
    • NPI 1801908975

    1355435900

    Same PAC ID

Other NPIs on the same Medicare enrollment 2

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

  • County of Brown

    dba Brown County Community Treatment Center - MD Group

    • Psychiatry Physician
    • Green Bay, WI
    • NPI 1679747059

    O20100524000844

    Same enrollment
  • County of Brown

    dba Brown County Community Treatment Center-Nicolet Psych

    • Psychiatric Hospital
    • Green Bay, WI
    • NPI 1801908975

    O20100524000844

    Same enrollment

National Provider Directory

National Provider Directory
Tax ID family
Brown Co HLTH Dept19 organizations share this tax ID, including this one
Part of
Brown Co HLTH Dept

Other organizations with this tax ID 18

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

View all 18

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Community Treatment CenterGreen Bay, WI, CCN 524014 Hospital Operational/Managerial Control Jan 1, 2010
Brown County Community Treatment Center - Bayshore VillageGreen Bay, WI, CCN 525693 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Adp of the SNF		 Oct 10, 2009
Oct 10, 2009

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • County of Brown

    dba Brown County Community Treatment Center-Bayshore Village

    • Skilled Nursing Facility
    • Green Bay, WI
    • NPI 1033214150

    5% Or Greater Direct Ownership Interest, Adp of the SNF

    CMS ownership
  • County of Brown

    dba Brown County Community Treatment Center-Nicolet Psych

    • Psychiatric Hospital
    • Green Bay, WI
    • NPI 1801908975

    Operational/Managerial Control

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 24

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 24

NPI Registry JSON

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715299200000",
    "number": "1942305065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3150 GERSHWIN DRIVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543115859",
            "telephone_number": "920-391-4839",
            "fax_number": "920-391-4870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3150 GERSHWIN DRIVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543115859",
            "telephone_number": "920-391-6940",
            "fax_number": "920-391-4870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF BROWN",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COUNTY OF BROWN",
        "enumeration_date": "2006-09-13",
        "last_updated": "2024-05-10",
        "certification_date": "2024-05-10",
        "status": "A",
        "authorized_official_last_name": "KILLIAN",
        "authorized_official_first_name": "ELIZA",
        "authorized_official_title_or_position": "BEHAVIORAL HEALTH SUPERVISOR",
        "authorized_official_telephone_number": "920-391-4700"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "510142673068",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42186400",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CC6458",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brown County Community Treatment Center - Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.