John Robert Otterbacher, PH.D-CLINICAL PSYCH

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301000990 Issued in MI

Practice address

146 Monroe Center
Suite 730
Grand Rapids, MI 49503

Phone

(616) 634-2467

Fax

(616) 454-2855

NPI assigned

Sep 5, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cornerstone Counseling and Consultation Services

  • Mental Health Counselor
  • Whitehall, MI
  • NPI 1174048995
  Medicare reassignment NPD

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

{
    "created_epoch": "1220572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1221523200000",
    "number": "1184872855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "146 MONROE CENTER",
            "address_2": "SUITE 730",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49503",
            "telephone_number": "616-634-2467",
            "fax_number": "616-454-2855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "146 MONROE CENTER",
            "address_2": "SUITE 730",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49503",
            "telephone_number": "616-634-2467",
            "fax_number": "616-454-2855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTTERBACHER",
        "first_name": "JOHN",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "PH.D-CLINICAL PSYCH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-05",
        "last_updated": "2008-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301000990",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth R Otten, PA-C
• Emily Ruth Otten
• Todd Richmond Otten, M.D.
• Hillary Maxine Ottenbaker, FNP-C
• Steven Ottenweller, MD
• Tijunae Diane Otterbridge
• Natasha Otterness, SLP
• Alexis Kathryn Otto, PA-C
• Emma Grace Ouellette
• Teresa Ouendag

• Clinical Psychologist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.