Michigan Institute of Performance and Health

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

MICHIGAN INSTITUTE OF PERFORMANCE AND HEALTH

Practice address

43902 Woodward Ave Ste 230
Bloomfield Hills, MI 48302-5022

Phone

(248) 481-8428

Fax

(248) 977-5462

NPI assigned

Sep 7, 2017

Last updated

Feb 1, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Mark S. Wells, LMSWNPI 1154648509

Title

Owner/Clinic Director

Phone

(248) 404-7151

Specialties & licenses 9

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 7

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.

• Mark Steven Wells, LMSW, CAADC, CCSOTS

  • Clinical Social Worker
  • Bloomfield Hills, MI
  • NPI 1154648509
  Medicare reassignment Care Compare group NPD Authorized official
• Elizabeth Carr, LPC, NCC

  • Professional Counselor
  • Detroit, MI
  • NPI 1396143590
  Medicare reassignment Care Compare group NPD
• Renee Harris, MD

  • Psychiatry Physician
  • Bloomfield Hills, MI
  • NPI 1043350895
  Medicare reassignment Care Compare group NPD
• Gwendolyn K La Croix, PMHNP-BC, RN

  • Psychiatric/Mental Health Nurse Practitioner
  • Milan, MI
  • NPI 1801343942
  Medicare reassignment Care Compare group NPD
• Chad Brynly Cubberly, L.M.S.W.

  • Clinical Social Worker
  • Bloomfield Hills, MI
  • NPI 1447809843

  Single Specialty

  Medicare reassignment NPD
• Izabella Edyta Michalik, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Livonia, MI
  • NPI 1699511717
  Medicare reassignment NPD
• Edith Susan Root-Clark, LMSW, CAADC

  • Clinical Social Worker
  • Detroit, MI
  • NPI 1689827768
  Medicare reassignment NPD

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

{
    "created_epoch": "1504742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706745600000",
    "number": "1174041321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43902 WOODWARD AVE STE 230",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483025022",
            "telephone_number": "248-481-8428",
            "fax_number": "248-977-5462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43902 WOODWARD AVE STE 230",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483025022",
            "telephone_number": "248-481-8428",
            "fax_number": "248-977-5462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIGAN INSTITUTE OF PERFORMANCE AND HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-07",
        "last_updated": "2024-02-01",
        "certification_date": "2024-02-01",
        "status": "A",
        "authorized_official_last_name": "WELLS",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "OWNER/CLINIC DIRECTOR",
        "authorized_official_telephone_number": "248-404-7151",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LMSW"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Military/U.S. Coast Guard Outpatient",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "VC0005376",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michigan Diagnostic Services, Inc
• Michigan Diagnostic Services, Inc
• Michigan Diagnostic Services, Inc
• Michigan Digestive Associates PC
• Michigan Expert Care and Staffing LLC
• Michigan Internal Medicine Center PC
• Michigan Light Therapy PC
• Michigan Mobile Medicine, PLLC
• Michigan Paratransit Services, LLC
• Michigan Psychological & Consulting Services PC

• Multi-Specialty Clinic/Center in Bloomfield Hills, MI
• Providers in Bloomfield Hills, MI by specialty
• Multi-Specialty Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2024; 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.