NPIMap

Organization Active NPI

Prairie Ridge Integrated Behavioral Healthcare

Doing business as Prairie Ridge

  • Substance Abuse Rehabilitation Facility
  • Mason City, IA
National Provider Identifier
1952443632
Registry record updated Aug 25, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
1201 Issued in IA
Legal business name
PRAIRIE RIDGE INTEGRATED BEHAVIORAL HEALTHCARE
Doing business as
Prairie Ridge
Practice address
320 N Eisenhower Ave
Mason City, IA 50401-1521
Phone
(641) 424-2391
NPI assigned
Feb 12, 2007
Last updated
Aug 25, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2017

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

Authorized official

Name
Mr. Jay Hansen
Title
Executive Director
Phone
(641) 424-2391

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 1201 IA
Substance Abuse Rehabilitation Facility 324500000X 1201 IA Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X 1201 IA
Addiction (Substance Use Disorder) Psychologist 103TA0400X 1201 IA

Addresses

Primary practice location

320 N Eisenhower Ave
Mason City, IA 50401-1521

Mailing address

PO Box 1338
Mason City, IA 50402-1338
Phone (641) 424-2391

Other names 1

  • Prairie Ridge Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20170908000404 IA Part B Supplier - Clinic/Group Practice 6800169194 Receives reassigned benefits from 35 practitioners
1 other NPI on this enrollment
Practice locations: Marshalltown, IA; Tama, IA; Osage, IA; Mason City, IA; Hampton, IA; Grinnell, IA; Forest City, IA; Eldora, IA…
O20250528000312 IA Part B Supplier - Opioid Treatment Program (Otp) 6800169194 1 other NPI on this enrollment
Practice locations: Mason City, IA

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

Locations

320 N Eisenhower Ave
Mason City, IA 50401
Phone (641) 423-1481

Practitioners & affiliated clinicians

Practitioners 47

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 47

NPI Registry JSON

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1503619200000",
    "number": "1952443632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1338",
            "city": "MASON CITY",
            "state": "IA",
            "postal_code": "504021338",
            "telephone_number": "641-424-2391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 N EISENHOWER AVE",
            "city": "MASON CITY",
            "state": "IA",
            "postal_code": "504011521",
            "telephone_number": "641-424-2391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE RIDGE INTEGRATED BEHAVIORAL HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-12",
        "last_updated": "2017-08-25",
        "status": "A",
        "authorized_official_last_name": "HANSEN",
        "authorized_official_first_name": "JAY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "641-424-2391",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "IA",
            "license": "1201",
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "IA",
            "license": "1201",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IA",
            "license": "1201",
            "primary": false
        },
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "IA",
            "license": "1201",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prairie Ridge",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mason City, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 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.