Brian Longhurst Merrill, DO

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

1851-321 Issued in WI

Practice address

100 Polk County PLZ Ste 180
Balsam Lake, WI 54810-8009

Phone

(715) 485-8876

NPI assigned

Jun 16, 2006

Last updated

Mar 1, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in MN, WI2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Psychiatry

Education

Arizona College of Osteopathic Medicine Mid Western University, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Polk County-Dept of AdministrationGroup PAC ID 4587560586, 2 clinicians

Southwestern Mental Health Center IncGroup PAC ID 7012816812, 16 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Polk County Dept of Administration

  • Community/Behavioral Health Agency
  • Balsam Lake, WI
  • NPI 1083837298
  Medicare reassignment Care Compare group NPD
• Southwestern Mental Health Center Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Luverne, MN
  • NPI 1487654562
  Medicare reassignment Care Compare group NPD
• Polk County-Dept of Administration

  dba Polk County Health Dept/Healthcheck

  • Public Health or Welfare Agency
  • Balsam Lake, WI
  • NPI 1295964435
  NPD
• Bear River Mental Health Services Inc

  • Mental Health Counselor
  • Logan, UT
  • NPI 1285736553
  NPD (past)

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677628800000",
    "number": "1982648929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 N 500 E",
            "address_2": "SUITE 330",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843412408",
            "telephone_number": "435-716-5790",
            "fax_number": "435-716-2921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 POLK COUNTY PLZ STE 180",
            "city": "BALSAM LAKE",
            "state": "WI",
            "postal_code": "548108009",
            "telephone_number": "715-485-8876"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1300 N 500 E",
            "address_2": "Suite 330",
            "address_purpose": "LOCATION",
            "city": "Logan",
            "state": "UT",
            "postal_code": "843412408",
            "country_code": "US",
            "telephone_number": "435-716-5790",
            "fax_number": "435-716-2921",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MERRILL",
        "first_name": "BRIAN",
        "middle_name": "LONGHURST",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2023-03-01",
        "certification_date": "2023-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MN",
            "license": "73041",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "UT",
            "license": "4993153",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WI",
            "license": "1851-321",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMBA",
            "identifier": "751650",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SELECTHEALTH",
            "identifier": "107012431102",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMIA",
            "identifier": "200521603BM2",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEHP",
            "identifier": "79126",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRSTHEALTH",
            "identifier": "200521603",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF UT",
            "identifier": "49931531200001",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Zoey L Larson, CNA
• Debra Ann Leschisin, RN-C
• Leah Loeffler
• Anita Lundquist, PHARMD
• Kathleen M McGurran, LSW
• Sara C Meuth, MSW APSW
• Kevin J Montague, MS, LPC, LSAC, LSW
• David N Moore, LSW
• Gerry R Morgan, LSW
• Emily C Ovik, SW LSW

• Psychiatry Physician in Balsam Lake, WI
• Providers in Balsam Lake, WI by specialty
• Psychiatry Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.