DRG CLINICAL, SC — NPI 1255048633 (Board-Certified Psychiatrist (Mental Health & Behavioral Medicine Physician) in WESTON, WI)

CMS-1500 Box 24J / 33a • NPI

1255048633

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

2084P0800X (CMS 26)

Board-Certified Psychiatrist (Mental Health & Behavioral Medicine Physician)

Box 32 Service Location & ZIP+4

5703 MEMORIAL CT, WESTON, WI, 54476-6502

✓ 9-Digit EDI 837 ZIP+4 (54476-6502)

Practice Phone & Referral Fax

(715) 204-9808

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1255048633 (DRG CLINICAL, SC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1255048633` (NPI-2 Organization / Facility)
Provider / Legal Name	DRG CLINICAL, SC
Plain-English Specialty	Board-Certified Psychiatrist (Mental Health & Behavioral Medicine Physician) NUCC Code: `2084P0800X` (Psychiatry & Neurology, Psychiatry)
Certifying / Licensing Body	American Board of Psychiatry and Neurology (ABPN)
Practice Location Address	5703 MEMORIAL CT, WESTON, WI, 54476-6502
Practice Telephone / Fax	Tel: (715) 204-9808
Administrative Mailing Address	5703 MEMORIAL CT, WESTON, WI, 54476-6502
Enumeration & Last Sync	Enumerated: 2022-11-03 \| CMS Record Updated: 2025-07-21
Authorized Official	ROBERT GOUTHRO (Owner)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

5703 MEMORIAL CT, WESTON, WI, 54476-6502

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Plain-English Taxonomy & CMS Crosswalk (2084P0800X)

What Does Taxonomy Code 2084P0800X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 2084P0800X translates to:
"Board-Certified Psychiatrist (Mental Health & Behavioral Medicine Physician)"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 26 (Physician/Psychiatry) • CMS Code 86 (Physician/Neuropsychiatry)
Certifying / Accrediting Authority: American Board of Psychiatry and Neurology (ABPN)
Clinical Scope: Depression, generalized anxiety, panic attacks, insomnia, bipolar disorder, OCD, PTSD, or medical recovery from substance dependence.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (DRG CLINICAL, SC)

Typical CPT / Diagnostic Procedures:

Comprehensive Psychiatric Diagnostic Evaluation (CPT 90792)
Psychopharmacological Management & Supportive Psychotherapy
Medication-Assisted Treatment (MAT) for Substance Use Disorders

Common Therapeutic Classes:

SSRIs & SNRIs (Sertraline, Escitalopram, Fluoxetine, Duloxetine)
Bupropion, Mirtazapine & Atypical Antipsychotics (Aripiprazole, Quetiapine)
Buprenorphine/Naloxone & Naltrexone (Addiction Recovery)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`1041C0700X` — Social Worker, Clinical Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical	State: N/A \| License: `Verified` \| Primary: Secondary
`106H00000X` — Marriage & Family Therapist Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Marriage and Family Therapist	State: N/A \| License: `Verified` \| Primary: Secondary
`2084P0800X` — Psychiatry & Neurology, Psychiatry Plain English: Board-Certified Psychiatrist (Mental Health & Behavioral Medicine Physician)	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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DRG CLINICAL, SC (NPI #1255048633)