Individual provider Active NPI

Lindsey L Bupp, PHD

  • Clinical Psychologist
  • Royal Oak, MI
National Provider Identifier
1013527134
Registry record updated Aug 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
6301018203 Issued in MI
Practice address
3007 N Altadena Ave
Royal Oak, MI 48073-3555
Phone
(520) 241-4044
NPI assigned
Aug 4, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 6301018203 MI Primary

Addresses

Primary practice location

3007 N Altadena Ave
Royal Oak, MI 48073-3555

Mailing address

3007 N Altadena Ave
Royal Oak, MI 48073-3555
Phone (520) 241-4044

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210211002588 CO Practitioner - Clinical Psychologist 1951716547 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Colorado Springs, CO 80917
Phone (888) 211-8537

3204 N Academy Blvd
Suite 200
Colorado Springs, CO 80917-5163

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
6301018203MIMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Sondermind Provider Network LLC Clinical CurrentSince Dec 9, 2020 Accepting new patients
Ppsoc PLLC Clinical CurrentSince Jun 1, 2023 Accepting new patients

Locations

3585 Van Teylingen Dr
Ste C
Colorado Springs, CO 80917
Phone (719) 510-7056

720 S Colorado Blvd
Ph N
Glendale, CO 80246
Phone (833) 988-0589

Networks

  • NM HMO C-SNP
  • devoted network organization-a4751131-f16f-4e82-8f2b-b08e66379a7a
  • CO HMO D-SNP
  • CO HMO

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1596499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596499200000",
    "number": "1013527134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3007 N ALTADENA AVE",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480733555",
            "telephone_number": "520-241-4044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3007 N ALTADENA AVE",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480733555",
            "telephone_number": "520-241-4044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUPP",
        "first_name": "LINDSEY",
        "middle_name": "L",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-04",
        "last_updated": "2020-08-04",
        "certification_date": "2020-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301018203",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Royal Oak, MI

Sources for this page

Verify at the official NPI Registry.