Elaine J Bruckner, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

5040 Issued in OH

Practice address

970 W Wooster St
Suite 124
Bowling Green, OH 43402-2643

Phone

(419) 352-6666

Fax

(419) 353-1117

NPI assigned

Oct 24, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

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, 1994

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Anxiety Treatment Center of Greater Toledo LLCGroup PAC ID 6507198199, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Anxiety Treatment Center of Greater Toledo LLC

  • Clinical Psychologist
  • Perrysburg, OH
  • NPI 1710539580
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1063596567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "970 W WOOSTER ST",
            "address_2": "SUITE 124",
            "city": "BOWLING GREEN",
            "state": "OH",
            "postal_code": "434022643",
            "telephone_number": "419-352-6666",
            "fax_number": "419-353-1117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "970 W WOOSTER ST",
            "address_2": "SUITE 124",
            "city": "BOWLING GREEN",
            "state": "OH",
            "postal_code": "434022643",
            "telephone_number": "419-352-6666",
            "fax_number": "419-353-1117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUCKNER",
        "first_name": "ELAINE",
        "middle_name": "J",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OH",
            "license": "5040",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason Brown
• Koleman Brown
• Laurie M. Brown, RN
• Richera J Brown
• Raiden Douglas Browning
• Mile Brujic, O.D.
• Sonia Ann Brujic, PHARM D
• Janet Brumbaugh, LSW
• Renee Sue Bruns
• Mindy Bruton, LMT

• Clinical Psychologist in Bowling Green, OH
• Providers in Bowling Green, OH by specialty
• Clinical Psychologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.