NPIMap

Organization Active NPI

Jefferson County Comprehensive

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Mount Vernon, IL
National Provider Identifier
1972533990
Registry record updated May 9, 2022
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
JEFFERSON COUNTY COMPREHENSIVE
Practice address
16342 N Il Hwy 37
Mt Vernon, IL 62864
Phone
(618) 242-1510
Fax
(618) 242-0958
NPI assigned
Jul 4, 2006
Last updated
May 9, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2022

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

Authorized official

Name
Mr. Dan Boehmer, C.E.O.
Title
C.E.O.
Phone
(618) 242-1510

Specialties & licenses 1

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

Addresses

Primary practice location

16342 N Il Hwy 37
Mt Vernon, IL 62864

Mailing address

PO Box 428
Mt Vernon, IL 62864
Phone (618) 242-1510

Other identifiers 3

IdentifierTypeStateIssuer
497770000OtherMAGELLAN
0004115177OtherILBCBS
372631OtherHEALTHLINK

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050810000128 IL Part B Supplier - Clinic/Group Practice 1153350103 Receives reassigned benefits from 3 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mount Vernon, IL

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
Tax ID family
Jefferson Co Comp Serv5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652054400000",
    "number": "1972533990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 428",
            "city": "MT VERNON",
            "state": "IL",
            "postal_code": "62864",
            "telephone_number": "618-242-1510",
            "fax_number": "618-242-0958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16342 N IL HWY 37",
            "city": "MT VERNON",
            "state": "IL",
            "postal_code": "62864",
            "telephone_number": "618-242-1510",
            "fax_number": "618-242-0958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON COUNTY COMPREHENSIVE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-04",
        "last_updated": "2022-05-09",
        "certification_date": "2022-05-09",
        "status": "A",
        "authorized_official_last_name": "BOEHMER",
        "authorized_official_first_name": "DAN",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "618-242-1510",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "C.E.O."
    },
    "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": "MAGELLAN",
            "identifier": "497770000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0004115177",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "372631",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2022; 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.