Active NPI
Cheryl Hope Hack, M.D.
- Developmental - Behavioral Pediatrics Physician
- Royal Oak, MI
National Provider Identifier
1144313107
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental - Behavioral Pediatrics Physician
- License
- 4301049051
- Practice address
- 30301 Woodward Ave
Suite LL 165
Royal Oak, MI 48073-0979 - Phone
- (248) 435-9240
- Fax
- (248) 435-4765
- NPI assigned
- Oct 2, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Developmental - Behavioral Pediatrics Physician | 2080P0006X | 4301049051 | MI | Primary |
Addresses
Primary practice location
30301 Woodward Ave
Suite LL 165
Royal Oak, MI 48073-0979
Mailing address
25219 W Roycourt
Huntington Woods, MI 48070-1741
Phone (248) 542-0660
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 41049 | Other | OMNICARE ID | |
| 4171928 | Medicaid | MI | |
| 11277774 | Other | CAQH PROVIDER ID | |
| 0004387354 | Other | AETNA ID | |
| 2199 | Other | CAPE ID | |
| 3506336142 | Other | MI | BCBS PIN NUMBER |
| 1003675 | Other | WELLNESS |
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301049051 | MI | MD | Developmental - Behavioral Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1144313107",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25219 W ROYCOURT",
"city": "HUNTINGTON WOODS",
"state": "MI",
"postal_code": "480701741",
"telephone_number": "248-542-0660"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30301 WOODWARD AVE",
"address_2": "SUITE LL 165",
"city": "ROYAL OAK",
"state": "MI",
"postal_code": "480730979",
"telephone_number": "248-435-9240",
"fax_number": "248-435-4765"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HACK",
"first_name": "CHERYL",
"middle_name": "HOPE",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0006X",
"taxonomy_group": "",
"desc": "Pediatrics, Developmental - Behavioral Pediatrics",
"state": "MI",
"license": "4301049051",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OMNICARE ID",
"identifier": "41049",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4171928",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH PROVIDER ID",
"identifier": "11277774",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA ID",
"identifier": "0004387354",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAPE ID",
"identifier": "2199",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PIN NUMBER",
"identifier": "3506336142",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLNESS",
"identifier": "1003675",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Royal Oak, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.