Active NPI
Robert Gray Perra, ED.D.
- Counseling Psychologist
- Sturgis, MI
National Provider Identifier
1225182264
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- 6301004082
- Practice address
- 103 S 4TH St
Sturgis, MI 49091-1819 - Phone
- (269) 651-3902
- Fax
- (269) 659-4874
- NPI assigned
- Jan 23, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | 6301004082 | MI | Primary |
Addresses
Primary practice location
103 S 4TH St
Sturgis, MI 49091-1819
Mailing address
11081 Greer Dr
Richland, MI 49083-9388
Phone (269) 731-4662
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 61-41803 | Medicaid | MI | |
| 014850 | Other | MI | CHAMPUS VA |
| M018978 | Other | MI | TRICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Psychological Services | Counseling | Past | Accepting new patients |
| Illume Wellness Group | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Psych Svcs SW Hi
- Mental Health Counselor
- Sturgis, MI
- NPI 1851501761
Counseling
-
- Professional Counselor
- Sturgis, MI
- NPI 1942978572
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1225182264",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11081 GREER DR",
"city": "RICHLAND",
"state": "MI",
"postal_code": "490839388",
"telephone_number": "269-731-4662",
"fax_number": "269-659-4874"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "103 S 4TH ST",
"city": "STURGIS",
"state": "MI",
"postal_code": "490911819",
"telephone_number": "269-651-3902",
"fax_number": "269-659-4874"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERRA",
"first_name": "ROBERT",
"middle_name": "GRAY",
"name_prefix": "Dr.",
"credential": "ED.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "MI",
"license": "6301004082",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "61-41803",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHAMPUS VA",
"identifier": "014850",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "M018978",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sturgis, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.