Bruce Patrick Hackworth, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

6801018724 Issued in MI

Practice address

811 Ship St
Suite 4B
Saint Joseph, MI 49085-1171

Phone

(269) 985-3618

Fax

(269) 609-6009

NPI assigned

Jun 23, 2006

Last updated

Jan 1, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

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

Specialty

Clinical Psychologist

Education

Other, 1996

Medicare assignment

May accept Medicare assignment

Group practices

Lighthouse Behavioral Health PLLCGroup PAC ID 7214249739, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/R4/

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

• Lighthouse Behavioral Health, PLLC

  • Counseling Psychologist
  • Saint Joseph, MI
  • NPI 1699155226
  Medicare reassignment Care Compare group Authorized official
• Lakeland Community Hospital Watervliet

  dba Corewell Health Watervliet Hospital Primary Care - Hartford

  • Rural Health Clinic/Center
  • Hartford, MI
  • NPI 1023114741
  Medicare reassignment NPD
• Lakeland Community Hospital Watervliet

  dba Corewell Health Watervliet Hospital

  • Rural Health Clinic/Center
  • Dowagiac, MI
  • NPI 1184467607
  NPD
• Lakeland Community Hospital Watervliet

  dba Corewell Health Watervliet Hospitals

  • Family Medicine Physician
  • Watervliet, MI
  • NPI 1568644052
  NPD
• Summit Pointe

  • Psychiatry Physician
  • Battle Creek, MI
  • NPI 1700833555

  Psychologist

  NPD (past)

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

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1451606400000",
    "number": "1063448918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 SHIP ST",
            "address_2": "SUITE 4B",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490851171",
            "telephone_number": "269-985-3618",
            "fax_number": "269-609-6009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 SHIP ST",
            "address_2": "SUITE 4B",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490851171",
            "telephone_number": "269-985-3618",
            "fax_number": "269-609-6009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HACKWORTH",
        "first_name": "BRUCE",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-23",
        "last_updated": "2016-01-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6801018724",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1716175",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LIGHTHOUSE BEHAVIORAL HEALTH PLLC - GROUP NPI",
            "identifier": "1699155226",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bettina E Grundler, MS, OTR/L
• Meghan Guntz, LMSW
• Alexander Gutfraynd, D.O.
• Dominique Jay Gutierrez, MD
• Hackett Chiropractic, LLC
• Gale Sandra Hackworth, PHD
• David Haddad, DDS
• Bailey Hadlich, MD
• Madison Hadlich, MD
• Deborah Kaye Hagey, OTR/L/MHS

• Psychologist in Saint Joseph, MI
• Providers in Saint Joseph, MI by specialty
• Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.