NPIMap

Organization Active NPI

Transitions Wellness Center LLC

  • Psychologist
  • Three Rivers, MI
National Provider Identifier
1215155403
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
6301010838 Issued in MI
Legal business name
TRANSITIONS WELLNESS CENTER LLC
Practice address
16587 Enterprise Dr
Three Rivers, MI 49093-7902
Phone
(269) 273-2024
Fax
(269) 273-3191
NPI assigned
Apr 23, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Michael R. BallardNPI 1982822169
Title
Owner
Phone
(269) 273-2024

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X 6301010838 MI Primary

Addresses

Primary practice location

16587 Enterprise Dr
Three Rivers, MI 49093-7902

Mailing address

16587 Enterprise Dr
Three Rivers, MI 49093-7902
Phone (269) 273-2024

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070619000353 MI Part B Supplier - Clinic/Group Practice 3476652330 Receives reassigned benefits from 9 practitioners
Practice locations: Three Rivers, MI

National Provider Directory

National Provider Directory

Locations

1519 N Main St
Ste C
Three Rivers, MI 49093
Phone (269) 273-2024

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1215155403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16587 ENTERPRISE DR",
            "city": "THREE RIVERS",
            "state": "MI",
            "postal_code": "490937902",
            "telephone_number": "269-273-2024",
            "fax_number": "269-273-3191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16587 ENTERPRISE DR",
            "city": "THREE RIVERS",
            "state": "MI",
            "postal_code": "490937902",
            "telephone_number": "269-273-2024",
            "fax_number": "269-273-3191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRANSITIONS WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BALLARD",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "269-273-2024"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301010838",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Three Rivers, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.