NPIMap

Organization Active NPI

Bloom Behavioral Health Partners PLLC

  • Mental Health Counselor
  • Grand Rapids, MI
National Provider Identifier
1174176366
Registry record updated Feb 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
BLOOM BEHAVIORAL HEALTH PARTNERS PLLC
Practice address
1514 Wealthy St SE Ste 242
Grand Rapids, MI 49506-2755
Phone
(616) 202-2138
Fax
(616) 228-8990
NPI assigned
Jul 17, 2019
Last updated
Feb 25, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2022

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

Authorized official

Name
Matthew Thatcher, L.P.C.NPI 1285917997
Title
Owner / Counselor
Phone
(616) 202-2138

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Primary
Counseling Psychologist 103TC1900X
Social Worker 104100000X
Clinical Social Worker 1041C0700X

Addresses

Primary practice location

1514 Wealthy St SE Ste 242
Grand Rapids, MI 49506-2755

Mailing address

1514 Wealthy St SE Ste 242
Grand Rapids, MI 49506-2755
Phone (616) 202-2138

Other practice location 1

333 W Western Ave Ste 5
Muskegon, MI 49440-1266
Phone (616) 202-2138

Other practice location 2

509 Franklin Ave
Grand Haven, MI 49417-1400
Phone (616) 202-2189

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL matt.thatcher@gmail.com

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220929000772 MI Part B Supplier - Clinic/Group Practice 3678959632 Receives reassigned benefits from 8 practitioners
Practice locations: Grand Haven, MI; Grand Rapids, MI

National Provider Directory

National Provider Directory

Locations

333 W Western Ave
Ste 5
Muskegon, MI 49440
Phone (616) 202-2138

4175 3 Mile Rd NW
Walker, MI 49534
Phone (616) 453-6100

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1563321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645747200000",
    "number": "1174176366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1514 WEALTHY ST SE STE 242",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495062755",
            "telephone_number": "616-202-2138",
            "fax_number": "616-228-8990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1514 WEALTHY ST SE STE 242",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495062755",
            "telephone_number": "616-202-2138",
            "fax_number": "616-228-8990"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "333 W Western Ave Ste 5",
            "address_purpose": "LOCATION",
            "city": "Muskegon",
            "state": "MI",
            "postal_code": "494401266",
            "country_code": "US",
            "telephone_number": "616-202-2138",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "509 Franklin Ave",
            "address_purpose": "LOCATION",
            "city": "Grand Haven",
            "state": "MI",
            "postal_code": "494171400",
            "country_code": "US",
            "telephone_number": "616-202-2189",
            "fax_number": "616-228-8990",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BLOOM BEHAVIORAL HEALTH PARTNERS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-17",
        "last_updated": "2022-02-25",
        "certification_date": "2022-02-25",
        "status": "A",
        "authorized_official_last_name": "THATCHER",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "OWNER / COUNSELOR",
        "authorized_official_telephone_number": "616-202-2138",
        "authorized_official_credential": "L.P.C."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "matt.thatcher@gmail.com",
            "affiliation": "N",
            "address_1": "333 W Western Ave Ste 5",
            "city": "Muskegon",
            "state": "MI",
            "country_code": "US",
            "postal_code": "494401266",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2022; 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.