NPIMap

Organization Active NPI

Michigan Behavioral Medicine PLLC

  • Psychiatry Physician
  • Troy, MI
National Provider Identifier
1144317116
Registry record updated May 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
MICHIGAN BEHAVIORAL MEDICINE PLLC
Practice address
2525 Crooks Rd
Suite #101
Troy, MI 48084-4733
Phone
(248) 731-7305
NPI assigned
Oct 9, 2006
Last updated
May 28, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 28, 2019

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

Authorized official

Name
Rene Joseph
Title
Administrator
Phone
(248) 703-1897

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X NU
Social Worker 104100000X NU
Psychiatry Physician 2084P0800X NU Primary

Addresses

Primary practice location

2525 Crooks Rd
Suite #101
Troy, MI 48084-4733

Mailing address

2525 Crooks Rd
Suite #100
Troy, MI 48084-1426
Phone (248) 731-7305

Other practice location 1

15370 LeVan Rd Ste 2A
Livonia, MI 48154-1903
Phone (734) 953-9100

Other identifiers 1

IdentifierTypeStateIssuer
10487OtherMABLUE CROSS NUMBER

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051219000372 MI Part B Supplier - Clinic/Group Practice 8325069305 Receives reassigned benefits from 27 practitioners
Practice locations: Troy, MI; Livonia, MI

National Provider Directory

National Provider Directory
Tax ID family
Michigan Behavioral Health3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

15370 Levan Rd
Ste 2A
Livonia, MI 48154
Phone (734) 953-9100

625 E Big Beaver Rd
#101
Troy, MI 48083
Phone (248) 740-9360

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 29

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1160352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559001600000",
    "number": "1144317116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2525 CROOKS RD",
            "address_2": "SUITE #100",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480841426",
            "telephone_number": "248-731-7305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 CROOKS RD",
            "address_2": "SUITE #101",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480844733",
            "telephone_number": "248-731-7305"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15370 LeVan Rd Ste 2A",
            "address_purpose": "LOCATION",
            "city": "Livonia",
            "state": "MI",
            "postal_code": "481541903",
            "country_code": "US",
            "telephone_number": "734-953-9100",
            "fax_number": "734-953-9201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MICHIGAN BEHAVIORAL MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-09",
        "last_updated": "2019-05-28",
        "status": "A",
        "authorized_official_last_name": "JOSEPH",
        "authorized_official_first_name": "RENE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "248-703-1897"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS NUMBER",
            "identifier": "10487",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Troy, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.