NPIMap

Organization Active NPI

Central Michigan University

  • Clinical Psychologist
  • Mt Pleasant, MI
National Provider Identifier
1073987616
Registry record updated Nov 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
CENTRAL MICHIGAN UNIVERSITY
Practice address
1101 Health Professions BLDG
Ste 2105
Mt Pleasant, MI 48859-0001
Phone
(989) 774-3904
Fax
(989) 774-1891
NPI assigned
Nov 19, 2015
Last updated
Nov 19, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2015

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

Authorized official

Name
Sheryl Sias
Title
Credentialing
Phone
(989) 774-2597

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC0700X Primary
School PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TS0200X

Addresses

Primary practice location

1101 Health Professions BLDG
Ste 2105
Mt Pleasant, MI 48859-0001

Mailing address

1101 Health Professions BLDG
Ste 2105
Mt Pleasant, MI 48859-0001
Phone (989) 774-3904

Other identifiers 1

IdentifierTypeStateIssuer
193400000XOtherTAXONOMY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040416000029 MI Part B Supplier - Clinic/Group Practice 3577558907 Receives reassigned benefits from 21 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Alma, MI; Mt Pleasant, MI

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Central Mich Univ8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1101 Health Professions
Mount Pleasant, MI 48859
Phone (989) 774-2597

NPI Registry JSON

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

{
    "created_epoch": "1447891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447891200000",
    "number": "1073987616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 HEALTH PROFESSIONS BLDG",
            "address_2": "STE 2105",
            "city": "MT PLEASANT",
            "state": "MI",
            "postal_code": "488590001",
            "telephone_number": "989-774-3904",
            "fax_number": "989-774-1891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 HEALTH PROFESSIONS BLDG",
            "address_2": "STE 2105",
            "city": "MT PLEASANT",
            "state": "MI",
            "postal_code": "488590001",
            "telephone_number": "989-774-3904",
            "fax_number": "989-774-1891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL MICHIGAN UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-19",
        "last_updated": "2015-11-19",
        "status": "A",
        "authorized_official_last_name": "SIAS",
        "authorized_official_first_name": "SHERYL",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "989-774-2597"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, School",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAXONOMY",
            "identifier": "193400000X",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mt Pleasant, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.