Active NPI
Samuel P Gross, MALLP, LPC, CSW
- Clinical Psychologist
- Shelby Township, MI
National Provider Identifier
1114085107
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6801057702
- Practice address
- 53950 Van Dyke Ave
Suite 210B
Shelby Township, MI 48316-1819 - Phone
- (586) 781-8400
- Fax
- (586) 781-8300
- NPI assigned
- Dec 4, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6801057702 | MI | Primary |
Addresses
Primary practice location
53950 Van Dyke Ave
Suite 210B
Shelby Township, MI 48316-1819
Mailing address
16991 Dublaine
Beverly Hills, MI 48025
Phone (248) 433-1069
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6801057702 | MI | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Downriver Mental Health Clinic PC | Past | Accepting new patients | |
| Counseling and Evaluation PLLC | Past | Accepting new patients | |
| Pro Med Management Inc | Past | Accepting new patients |
Interoperability endpoints
- lifestancehealth.samuelgross@150339.advancedmd-direct.com
Organizations & group practices 3
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Shelby TWP, MI
- NPI 1588609861
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Shelby TWP, MI
- NPI 1477590917
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1396569600000",
"number": "1114085107",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16991 DUBLAINE",
"city": "BEVERLY HILLS",
"state": "MI",
"postal_code": "48025",
"telephone_number": "248-433-1069"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "53950 VAN DYKE AVE",
"address_2": "SUITE 210B",
"city": "SHELBY TOWNSHIP",
"state": "MI",
"postal_code": "483161819",
"telephone_number": "586-781-8400",
"fax_number": "586-781-8300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GROSS",
"first_name": "SAMUEL",
"middle_name": "P",
"name_prefix": "Mr.",
"credential": "MALLP, LPC, CSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-04",
"last_updated": "2014-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6801057702",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shelby Township, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.