UHS THE MIDWEST CENTER FOR YOUTH & FAMILIES
Complete NPI Record 1649243759
Residential Treatment Facility, Emotionally Disturbed Children in Kouts, IN

Complete NPI Dataset

This page represents the complete record for NPI 1649243759. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1649243759

The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.

Entity Type Code: 2

Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).

Employer Identification Number EIN: UNAVAIL

The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.

Provider Organization Name Legal Business Name: UHS THE MIDWEST CENTER FOR YOUTH & FAMILIES

The name of the organization provider. If the provider is an organization, this is the legal business name.

Provider First Line Business Mailing Address: P.O. BOX 669

The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".

Provider Second Line Business Mailing Address: 1012 N. INDIANA ST

The second line mailing address of the provider being identified. This data element may contain the same information as "Provider second line location address".

Provider Business Mailing Address City Name: KOUTS

The city name in the mailing address of the provider being identified.

Provider Business Mailing Address State Name: IN

The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".

Provider Business Mailing Address Postal Code: 463479703

The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".

Provider Business Mailing Address Country Code If outside U S : US

The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".

Provider Business Mailing Address Telephone Number: 2197662999

The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".

Provider Business Mailing Address Fax Number: 2197662704

The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".

Provider First Line Business Practice Location Address: 1012 W. INDIANA ST

The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Business Practice Location Address City Name: KOUTS

The city name in the location address of the provider being identified.

Provider Business Practice Location Address State Name: IN

The State code in the location of the provider being identified.

Provider Business Practice Location Address Postal Code: 463479703

The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.

Provider Business Practice Location Address Country Code If outside U S : US

The country code in the location address of the provider being identified.

Provider Business Practice Location Address Telephone Number: 2197662999

The telephone number associated with the location address of the provider being identified.

Provider Business Practice Location Address Fax Number: 2197662704

The fax number associated with the location address of the provider being identified.

Provider Enumeration Date: 2/9/2006

The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date: 7/3/2012

The date that a record was last updated or changed.

Authorized Official Last Name: PERRY

The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.

Authorized Official First Name: MICHAEL

The first name of the authorized official.

Authorized Official Middle Name: JOHN

The middle name of the authorized official.

Authorized Official Title or Position: CEO

The title or position of the authorized official.

Authorized Official Telephone Number: 2197662999

The 10-position telephone number of the authorized official.

Healthcare Provider Taxonomy Code 1: 103TC2200X

This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.

Provider License Number 1: 73540

The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with "provider taxonomy code".

Provider License Number State Code 1: IN

The two-letter state code representing the U.S. state or territory that issued the provider's license. This field is linked to the Provider License Number field and identifies the jurisdiction where that license is valid. A provider may have multiple state codes if they hold licenses in more than one state.

Healthcare Provider Primary Taxonomy Switch 1: N

This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.

Healthcare Provider Taxonomy Code 2: 103TC0700X

This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.

Provider License Number 2: 73540

The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with "provider taxonomy code".

Provider License Number State Code 2: IN

The two-letter state code representing the U.S. state or territory that issued the provider's license. This field is linked to the Provider License Number field and identifies the jurisdiction where that license is valid. A provider may have multiple state codes if they hold licenses in more than one state.

Healthcare Provider Primary Taxonomy Switch 2: N

This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.

Healthcare Provider Taxonomy Code 3: 103TF0000X

This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.

Provider License Number 3: 73540

The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with "provider taxonomy code".

Provider License Number State Code 3: IN

The two-letter state code representing the U.S. state or territory that issued the provider's license. This field is linked to the Provider License Number field and identifies the jurisdiction where that license is valid. A provider may have multiple state codes if they hold licenses in more than one state.

Healthcare Provider Primary Taxonomy Switch 3: N

This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.

Healthcare Provider Taxonomy Code 4: 103TP2701X

This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.

Provider License Number 4: 73540

The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with "provider taxonomy code".

Provider License Number State Code 4: IN

The two-letter state code representing the U.S. state or territory that issued the provider's license. This field is linked to the Provider License Number field and identifies the jurisdiction where that license is valid. A provider may have multiple state codes if they hold licenses in more than one state.

Healthcare Provider Primary Taxonomy Switch 4: N

This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.

Healthcare Provider Taxonomy Code 5: 2084P0800X

This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.

Provider License Number 5: 73540

The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with "provider taxonomy code".

Provider License Number State Code 5: IN

The two-letter state code representing the U.S. state or territory that issued the provider's license. This field is linked to the Provider License Number field and identifies the jurisdiction where that license is valid. A provider may have multiple state codes if they hold licenses in more than one state.

Healthcare Provider Primary Taxonomy Switch 5: N

This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.

Healthcare Provider Taxonomy Code 6: 323P00000X

This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.

Provider License Number 6: 73540

The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with "provider taxonomy code".

Provider License Number State Code 6: IN

The two-letter state code representing the U.S. state or territory that issued the provider's license. This field is linked to the Provider License Number field and identifies the jurisdiction where that license is valid. A provider may have multiple state codes if they hold licenses in more than one state.

Healthcare Provider Primary Taxonomy Switch 6: N

This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.

Healthcare Provider Taxonomy Code 7: 323P00000X

This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.

Provider License Number 7: 50266819873831

The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with "provider taxonomy code".

Provider License Number State Code 7: IN

The two-letter state code representing the U.S. state or territory that issued the provider's license. This field is linked to the Provider License Number field and identifies the jurisdiction where that license is valid. A provider may have multiple state codes if they hold licenses in more than one state.

Healthcare Provider Primary Taxonomy Switch 7: N

This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.

Healthcare Provider Taxonomy Code 8: 101YM0800X

This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.

Provider License Number 8: 5180909873540

The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with "provider taxonomy code".

Provider License Number State Code 8: IN

The two-letter state code representing the U.S. state or territory that issued the provider's license. This field is linked to the Provider License Number field and identifies the jurisdiction where that license is valid. A provider may have multiple state codes if they hold licenses in more than one state.

Healthcare Provider Primary Taxonomy Switch 8: N

This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.

Healthcare Provider Taxonomy Code 9: 322D00000X

This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.

Provider License Number 9: 5180909873540

The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with "provider taxonomy code".

Provider License Number State Code 9: IN

The two-letter state code representing the U.S. state or territory that issued the provider's license. This field is linked to the Provider License Number field and identifies the jurisdiction where that license is valid. A provider may have multiple state codes if they hold licenses in more than one state.

Healthcare Provider Primary Taxonomy Switch 9: Y

This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.

Other Provider Identifier 1: 200465920A

An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.

Other Provider Identifier Type Code 1: 05

A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.

Other Provider Identifier State 1: IN

The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.

Is Organization Subpart: N

Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.

Authorized Official Name Prefix Text: MR.

The prefix used in the name of the authorized official associated with the provider's NPI record. Examples include Mr., Ms., Mrs., Dr., or other common professional or personal prefixes.

Healthcare Provider Taxonomy Group 1: 193400000X MULTIPLE SINGLE SPECIALTY GROUP

Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.

Healthcare Provider Taxonomy Group 2: 193400000X MULTIPLE SINGLE SPECIALTY GROUP

Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.

Healthcare Provider Taxonomy Group 3: 193400000X MULTIPLE SINGLE SPECIALTY GROUP

Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.

Healthcare Provider Taxonomy Group 4: 193400000X MULTIPLE SINGLE SPECIALTY GROUP

Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.

Healthcare Provider Taxonomy Group 5: 193400000X MULTIPLE SINGLE SPECIALTY GROUP

Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.

Healthcare Provider Taxonomy Group 8: 193400000X MULTIPLE SINGLE SPECIALTY GROUP

Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.