Individual provider Active NPI

Michelle L Rose-Barajas, PSY.D.

  • Addiction (Substance Use Disorder) Psychologist
  • Janesville, WI
National Provider Identifier
1144246182
Registry record updated Nov 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) PsychologistTaxonomy code 103TA0400X
License
2969-57 Issued in WI
Practice address
903 Mineral Point Ave
Janesville, WI 53548-2970
Phone
(608) 756-5555
Fax
(608) 756-0174
NPI assigned
Jul 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 510-126 WI
Addiction (Substance Use Disorder) Psychologist 103TA0400X 2969-57 WI Primary

Addresses

Primary practice location

903 Mineral Point Ave
Janesville, WI 53548-2970

Mailing address

903 Mineral Point Ave
Janesville, WI 53548-2970
Phone (608) 756-5555

Other identifiers 1

IdentifierTypeStateIssuer
43590100MedicaidWI

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20130130000212 WI Practitioner - Clinical Psychologist 0840444733 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Health System CorporationGroup PAC ID 7416860440, 749 clinicians

Practice addresses (Care Compare)

903 Mineral Point Ave
Janesville, WI 53548-2970
Phone (608) 754-3814

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
510-126WIMDProfessional Counselor
2969-57WIMDAddiction (Substance Use Disorder) Psychologist
2969WIMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health System Corporation CurrentSince Dec 17, 2012 Accepting new patients
Mercy Health System Corporation CurrentSince Dec 17, 2012 Accepting new patients

Locations

29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652

903 Mineral Point Ave
Janesville, WI 53548
Phone (608) 756-5555

1000 Mineral Point Ave
Janesville, WI 53548
Phone (608) 261-6868

N2950 State Road 67
Lake Geneva, WI 53147
Phone (262) 245-0535

Interoperability endpoints

  • Direct secure messaging: mrosebarajas16801@direct.mhemail.org

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": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352678400000",
    "number": "1144246182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "903 MINERAL POINT AVE",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535482970",
            "telephone_number": "608-756-5555",
            "fax_number": "608-756-0174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "903 MINERAL POINT AVE",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535482970",
            "telephone_number": "608-756-5555",
            "fax_number": "608-756-0174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSE-BARAJAS",
        "first_name": "MICHELLE",
        "middle_name": "L",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-14",
        "last_updated": "2012-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "510-126",
            "primary": false
        },
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "2969-57",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43590100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Janesville, WI

Sources for this page

Verify at the official NPI Registry.