Individual provider Active NPI

Kathrine Mobisson III, M.D.

  • Psychiatry Physician
  • Roseville, MI
National Provider Identifier
1124102223
Registry record updated Mar 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
4301102263 Issued in MI
Practice address
25869 Kelly Rd
Suite a
Roseville, MI 48066-4997
Phone
(586) 773-6020
Fax
(586) 773-6093
NPI assigned
Oct 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2014

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X
Psychiatry Physician 2084P0800X 4301102263 MI Primary
Child & Adolescent Psychiatry Physician 2084P0804X 4301102263 MI

Addresses

Primary practice location

25869 Kelly Rd
Suite a
Roseville, MI 48066-4997

Mailing address

25869 Kelly Rd
Suite a
Roseville, MI 48066-4997
Phone (586) 773-6020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130513000431 MI Practitioner - Psychiatry 3870684095 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Duke University School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Biological Psychiatry Center, PCGroup PAC ID 8820067200, 8 clinicians

Practice addresses (Care Compare)

25869 Kelly Rd
Suite a
Roseville, MI 48066-4997
Phone (586) 773-6020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Biological Psychiatry Center, P.C. Psychiatry CurrentSince Apr 15, 2013 Accepting new patients
Biological Psychiatry Center, PC Psychiatry PastSince Apr 15, 2013 Accepting new patients

Locations

25869 Kelly Rd
Ste A
Roseville, MI 48066
Phone (586) 773-6020

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395705600000",
    "number": "1124102223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25869 KELLY RD",
            "address_2": "SUITE A",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480664997",
            "telephone_number": "586-773-6020",
            "fax_number": "586-773-6093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25869 KELLY RD",
            "address_2": "SUITE A",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480664997",
            "telephone_number": "586-773-6020",
            "fax_number": "586-773-6093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOBISSON",
        "first_name": "KATHRINE",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-25",
        "last_updated": "2014-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "4301102263",
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "MI",
            "license": "4301102263",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, MI

Sources for this page

Verify at the official NPI Registry.