INDEPENDENCE HEALTH CENTER AT JEFFERSON CENTER FOR MENTAL HEALTH
Complete NPI Record 1316233174
Clinic/Center - Federally Qualified Health Center (FQHC) in Wheat Ridge, CO
Active since June 21, 2011
Complete NPI Dataset
This page contains the complete raw NPPES record for Independence Health Center At Jefferson Center For Mental Health (NPI 1316233174), a clinic/center organization in Wheat Ridge, CO. All 38 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1316233174 Field 1/38
- 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 Field 2/38
- 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: Not available Field 3/38
- The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
- Provider Organization Name Legal Business Name: METRO COMMUNITY PROVIDER NETWORK, INC. Field 4/38
- The name of the organization provider. If the provider is an organization, this is the legal business name.
- Provider Other Organization Name: INDEPENDENCE HEALTH CENTER AT JEFFERSON CENTER FOR MENTAL HEALTH Field 5/38
- Other name by which the organization provider is or has been known.
- Provider Other Organization Name Type Code: 5 Field 6/38
- Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
- Provider First Line Business Mailing Address: 2255 S ONEIDA ST Field 7/38
- 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 Business Mailing Address City Name: DENVER Field 8/38
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: CO Field 9/38
- 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: 802242522 Field 10/38
- 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 Field 11/38
- 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: 3037611977 Field 12/38
- 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: 3037612787 Field 13/38
- 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: 4851 INDEPENDENCE STREET Field 14/38
- 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: WHEAT RIDGE Field 15/38
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: CO Field 16/38
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 800336715 Field 17/38
- 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 Field 18/38
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 3032747094 Field 19/38
- The telephone number associated with the location address of the provider being identified.
- Provider Business Practice Location Address Fax Number: 3032747095 Field 20/38
- The fax number associated with the location address of the provider being identified.
- Authorized Official Last Name: WIEDERHOLT Field 23/38
- 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: BEN Field 24/38
- The first name of the authorized official.
- Authorized Official Middle Name: R. Field 25/38
- The middle name of the authorized official.
- Authorized Official Title or Position: PRESIDENT AND CEO Field 26/38
- The title or position of the authorized official.
- Authorized Official Telephone Number: 3037611977 Field 27/38
- The 10-position telephone number of the authorized official.
- Healthcare Provider Taxonomy Code 1: 261QF0400X Field 28/38
- 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 State Code 1: CO Field 29/38
- 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: Y Field 30/38
- 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: 58038230 Field 31/38
- 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 Field 32/38
- 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: CO Field 33/38
- 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: Y Field 34/38
- 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.
- Parent Organization LBN: METRO COMMUNITY PROVIDER NETWORK, INC. Field 35/38
- The Legal Business Name (LBN) of the parent organization, if the provider is a subpart of a larger entity. This field identifies the official registered name of the parent company or organization under which the provider operates.
- Parent Organization TIN: Not available Field 36/38
- The Taxpayer Identification Number (TIN) of the parent organization, provided when the provider is a subpart of a larger entity. This field identifies the federal tax ID used by the parent organization for official and billing purposes.
- Authorized Official Name Prefix Text: MR. Field 37/38
- 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.
Other Organization Names 1
Additional business and trade names this provider has on file with the NPPES registry.
STRIDE CHC - Independence at Jefferson Center Doing Business As
Name 1/1Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.
Other Provider Identifiers 1
Legacy and payer-issued identifiers reported to the NPPES registry for this provider.
58038230 Medicaid
Identifier 1/1State: CO
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.
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