Patchawan Phunwutikorn, PSYD

Primary specialty

PsychologistTaxonomy code 103T00000X

Practice address

1 Genesys Pkwy
Grand Blanc, MI 48439-8065

Phone

(810) 606-5126

NPI assigned

May 26, 2017

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI, VA2 enrollments

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 2

Specialty

Clinical Psychologist

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Henry Ford Health Genesys HospitalGroup PAC ID 2062323033, 85 clinicians

Assessment and Therapy AssociatesGroup PAC ID 2062581481, 21 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ascension Genesys Hospital Hospital, Grand Blanc, MI, CCN 230197

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/8209/brand/5/csg/21/fhir/r4

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.

• Henry Ford Health Genesys Hospital

  • Podiatrist
  • Flint, MI
  • NPI 1528283033
  Medicare reassignment Care Compare group NPD
• Assessment & Therapy Associates PC

  • Clinical Psychologist
  • Chesapeake, VA
  • NPI 1922286707
  Medicare reassignment Care Compare group NPD
• Genesys Practice Partners Inc

  • Family Medicine Physician
  • Grand Blanc, MI
  • NPI 1982647004
  Medicare reassignment NPD
• Ascension Genesys Hospital

  • Skilled Nursing Facility
  • Grand Blanc, MI
  • NPI 1093125312
  NPD
• Genesys Practice Partners Inc

  • Family Medicine Physician
  • Grand Blanc, MI
  • NPI 1194774752
  NPD
• Genesys Practice Partners, Inc

  • Psychiatry Physician
  • Grand Blanc, MI
  • NPI 1336842160
  NPD
• Henry Ford Health Genesys Hospital

  • Clinical Psychologist
  • Burton, MI
  • NPI 1932368537
  NPD
• Genesys Practice Partners Inc

  • Physician Assistant
  • Grand Blanc, MI
  • NPI 1114060837
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Henry Ford Health Genesys Hospital

  • General Acute Care Hospital
  • Grand Blanc, MI
  • NPI 1407877723
  Care Compare affiliation

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

{
    "created_epoch": "1495756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660694400000",
    "number": "1114455706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2004 FOX HILL DR APT 1",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484395244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 GENESYS PKWY",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484398065",
            "telephone_number": "810-606-5126"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2325 Clement Ave Ste A",
            "address_purpose": "LOCATION",
            "city": "Alameda",
            "state": "CA",
            "postal_code": "945017061",
            "country_code": "US",
            "telephone_number": "510-629-6367",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHUNWUTIKORN",
        "first_name": "PATCHAWAN",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-05-26",
        "last_updated": "2022-08-17",
        "certification_date": "2022-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8121",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kotrina Peterson
• Natilly Peterson
• Ivana Petrovski
• Lisa Marie Petzold-Young
• Julie Ann Phillips
• Physical Therapy Company, PLLC
• Physician Coverage Services
• Physician Coverage Services
• Physiotherapy Associates Inc
• Alexis Lashae Pickett

• Psychologist in Grand Blanc, MI
• Providers in Grand Blanc, MI by specialty
• Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2022; 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.