NPIMap

Organization Active NPI

Wellsource

  • Psychologist
  • Mason City, IA
National Provider Identifier
1992818249
Registry record updated Jan 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
WELLSOURCE
Practice address
235 S Eisenhower Avenue
Mason City, IA 50401
Phone
(641) 424-2075
Fax
(641) 424-9555
NPI assigned
Aug 17, 2006
Last updated
Jan 23, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2015

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

Authorized official

Name
Mr. Andrew M Eastwood, MSW
Title
Executive Director
Phone
(641) 424-2075

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X Primary
Social Worker 104100000X
Registered Nurse 163W00000X
Psychiatry Physician 2084P0800X

Addresses

Primary practice location

235 S Eisenhower Avenue
Mason City, IA 50401

Mailing address

235 S Eisenhower Avenue
Mason City, IA 50401
Phone (641) 424-2075

Other identifiers 1

IdentifierTypeStateIssuer
00065243MedicaidIA

Other names 1

  • Mental Health Center of North Iowa, Inc Former legal business name

National Provider Directory

National Provider Directory

Locations

101 S Main St
Charles City, IA 50616
Phone (641) 424-2075

123 1st St NW
Hampton, IA 50441
Phone (641) 424-2075

1000 Central Ave
Northwood, IA 50459
Phone (641) 424-2075

415 Pleasant St
Osage, IA 50461
Phone (641) 424-2075

Practitioners & affiliated clinicians

Practitioners 39

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 39

NPI Registry JSON

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421971200000",
    "number": "1992818249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 S EISENHOWER AVENUE",
            "city": "MASON CITY",
            "state": "IA",
            "postal_code": "50401",
            "telephone_number": "641-424-2075",
            "fax_number": "641-424-9555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 S EISENHOWER AVENUE",
            "city": "MASON CITY",
            "state": "IA",
            "postal_code": "50401",
            "telephone_number": "641-424-2075",
            "fax_number": "641-424-9555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSOURCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-17",
        "last_updated": "2015-01-23",
        "status": "A",
        "authorized_official_last_name": "EASTWOOD",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "641-424-2075",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00065243",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mental Health Center of North Iowa, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 Jan 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.