NPIMap

Organization Active NPI

Mental Health Clinic

  • Psychiatry Physician
  • Portage, MI
National Provider Identifier
1184822769
Registry record updated Oct 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
RM4301052512 Issued in MI
Legal business name
MENTAL HEALTH CLINIC
Practice address
1514 W Milham Ave
Portage, MI 49024-1296
Phone
(269) 342-0606
Fax
(269) 342-0919
NPI assigned
Jul 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2008

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

Authorized official

Name
Dr. Ravinder P Mediratta, M D
Title
Owner
Phone
(269) 342-0606

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YM0800X 6401009051 MI
Psychiatry PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084P0800X RM4301052512 MI Primary

Addresses

Primary practice location

1514 W Milham Ave
Portage, MI 49024-1296

Mailing address

1514 W Milham Ave
Portage, MI 49024-1296
Phone (269) 342-0606

National Provider Directory

National Provider Directory

Locations

1514 W Milham Ave
Portage, MI 49024
Phone (269) 342-0606

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1183593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223510400000",
    "number": "1184822769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1514 W MILHAM AVE",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490241296",
            "telephone_number": "269-342-0606",
            "fax_number": "269-342-0919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1514 W MILHAM AVE",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490241296",
            "telephone_number": "269-342-0606",
            "fax_number": "269-342-0919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENTAL HEALTH CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-05",
        "last_updated": "2008-10-09",
        "status": "A",
        "authorized_official_last_name": "MEDIRATTA",
        "authorized_official_first_name": "RAVINDER",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "269-342-0606",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M D"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "MI",
            "license": "6401009051",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "RM4301052512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portage, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.