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BROCK DAVIS VERN SCHULTZ LPC-IT
NPI 1902552417
Counselor - Professional in Monona, WI

Active since February 23, 2022PECOS EnrolledAccepts Medicare Assignment
1955 W BROADWAY STE 104, MONONA, WI 53713(608) 395-1795 Get Directions Write a Review

NPPES record last updated: February 23, 2022. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Brock Davis Vern Schultz Lpc-it NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BROCK DAVIS VERN SCHULTZ LPC-IT (NPI 1902552417) is an individual professional provider in Monona, Wisconsin, licensed in Wisconsin (3887-226) and active in the NPI registry since February 2022. He is enrolled in Medicare PECOS and is a graduate of Other (2013).

NPPES Registry Identity

NPI1902552417
Entity TypeIndividualMale
Primary Taxonomy101YP2500X
Provider Legal NameBROCK DAVIS VERN SCHULTZCredential: LPC-IT
Location Address1955 W BROADWAY STE 104Monona, WI 53713-3700
Mailing Address1955 W Broadway Ste 104Monona, WI 53713-3700 · (608) 395-1795
Phone(608) 395-1795
Sole ProprietorNo
Medical School CMSOtherGraduated 2013
Enumeration DateFebruary 23, 2022
NPPES CertifiedFebruary 23, 2022
✔ NPI 1902552417 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
License✔ Licensed in WI · 3887-226
1955 W BROADWAY STE 104, Monona, WI 53713
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Group Health Cooperative-SCW, Quartz, UnitedHealthcare.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Brock Davis Vern Schultz Lpc-it is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID5991214223
PECOS Enrollment IDI20250529003581
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Brock Schultz reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Our Generations Inc.
Same address
Professional
1955 W. BROADWAY STE 104
Monona, WI 53713
  • Reassigned Medicare billing, Wisconsin enrollment
  • 4 clinicians in this Medicare group
NPI 1609520204 (608) 405-3002

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ASHLEY BARRY LPC-IT
Counselor (Mental Health)
1955 W BROADWAY STE 104
MONONA, WI 53713
Dane County (608) 405-3002
RUCHITA ERVIN
Counselor (Professional)
1955 W BROADWAY STE 104
MONONA, WI 53713
Dane County (608) 405-3002
GUADALUPE ORTIZ
Counselor (Addiction (Substance Use Disorder))
1955 W BROADWAY STE 104
MONONA, WI 53713
Dane County (608) 405-3002
AMADOU O SAM APSW
Social Worker
1955 W BROADWAY STE 104
MONONA, WI 53713
Dane County (608) 217-2650
SARAH AURELIA GROESCHEL MS, LPC
Counselor (Professional)
1955 W BROADWAY STE 104
MONONA, WI 53713
Dane County (608) 405-3002

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Brock Schultz's NPI number?

The NPI number for Brock Schultz is 1902552417. It was assigned to this individual provider in the NPPES registry on February 23, 2022.

Where is Brock Schultz located?

Brock Schultz practices at 1955 W Broadway Ste 104, Monona, WI 53713. The listed phone number is (608) 395-1795.

What is Brock Schultz's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Is Brock Schultz enrolled in Medicare?

Yes. Brock Schultz is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Brock Schultz's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Brock Schultz reassigns Medicare benefits to Our Generations Inc. (Monona, WI). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Brock Schultz's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Brock Schultz accept?

Health plans from Group Health Cooperative-SCW, Quartz and UnitedHealthcare list Brock Schultz as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Brock Schultz was last updated on February 23, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.