Michael David Brodeur, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY60297192 Issued in WA

Practice address

1815 NE Wilson Rd
Pullman, WA 99164-0001

Phone

(509) 335-4511

NPI assigned

Jan 11, 2013

Last updated

Jan 11, 2013By the provider in NPPES

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 RI

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

Specialty

Clinical Psychologist

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Providence Behavioral Health Associates IncGroup PAC ID 3274798236, 19 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Providence Behavioral Health Associates Inc

  • Clinical Psychologist
  • Providence, RI
  • NPI 1023142700
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1357862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1357862400000",
    "number": "1225375165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 PALOUSE VW",
            "city": "PULLMAN",
            "state": "WA",
            "postal_code": "991635261",
            "telephone_number": "401-447-0459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1815 NE WILSON RD",
            "city": "PULLMAN",
            "state": "WA",
            "postal_code": "991640001",
            "telephone_number": "509-335-4511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODEUR",
        "first_name": "MICHAEL",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-01-11",
        "last_updated": "2013-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "PY60297192",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lennis K Boyer, MD
• Kristine Ellen Brenc, NP-C
• Anthony Demetris Bright, PHARMD
• Brighton Rehabilitation LLC (Brighton Rehabilitation Services)
• Brighton Rehabilitation, LLC
• Kaz B Brodsky, MD
• Joshua Callum Brooker
• Jennifer Lynne Brossman, ATC, AT/L
• Larry E Brown, M.D.
• Loren B Brown, PHD

• Clinical Psychologist in Pullman, WA
• Providers in Pullman, WA by specialty
• Clinical Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2013; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.