Active NPI
Bloom Behavioral Health Partners PLLC
- Mental Health Counselor
- Grand Rapids, MI
National Provider Identifier
1174176366
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- 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
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Matthew Thatcher, L.P.C.
- 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) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | matt.thatcher@gmail.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 DirectoryLocations
1514 Wealthy St SE
Ste 242
Grand Rapids, MI 49506
Phone (616) 202-2138
333 W Western Ave
Ste 5
Muskegon, MI 49440
Phone (616) 202-2138
Practitioners & affiliated clinicians
Practitioners 16
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Clinical Social Worker
- Grand Rapids, MI
- NPI 1447526272
Clinical, MI
-
- Clinical Social Worker
- Evanston, IL
- NPI 1306193198
Clinical, MI
-
- Clinical Social Worker
- Spring Lake, MI
- NPI 1447369335
Clinical
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": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
},
{
"code": "103TC1900X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychologist, Counseling",
"state": null,
"license": null,
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Social Worker",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "193200000X MULTI-SPECIALTY 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.