Individual provider Active NPI

Bernice S Patterson, LLP

  • Psychologist
  • Kalamazoo, MI
National Provider Identifier
1225383375
Registry record updated Apr 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
6361007506 Issued in MI
Practice address
5887 Larkwood CT Apt 1B
Kalamazoo, MI 49048-6648
Phone
(833) 342-4552
NPI assigned
Jul 16, 2012
Last updated
Apr 30, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 6301015177 MI
Psychologist 103T00000X 6361007506 MI Primary

Addresses

Primary practice location

5887 Larkwood CT Apt 1B
Kalamazoo, MI 49048-6648

Mailing address

PO Box 94
Nazareth, MI 49074-0094
Phone (833) 342-4552

Other practice location 1

1350 W Centre Ave
Portage, MI 49024-5361
Phone (269) 910-7327

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210623001029 MI Practitioner - Psychologist Billing Independently 2769891167 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
6301015177MIMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Infinity Consultation Group Psychologist CurrentSince Jun 10, 2021 Accepting new patients
Pine Rest Christian Mental Health Services PastSince Sep 1, 2020 Accepting new patients
Pine Rest Christian Mental Health Services Psychologist PastSince Sep 1, 2020 Accepting new patients

Locations

281 120th Ave
Holland, MI 49424
Phone (616) 834-1819

5073 Gull Rd
#94
Kalamazoo, MI 49048
Phone (833) 342-4552

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1342396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619740800000",
    "number": "1225383375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 94",
            "city": "NAZARETH",
            "state": "MI",
            "postal_code": "490740094",
            "telephone_number": "833-342-4552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5887 LARKWOOD CT APT 1B",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490486648",
            "telephone_number": "833-342-4552"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1350 W Centre Ave",
            "address_purpose": "LOCATION",
            "city": "Portage",
            "state": "MI",
            "postal_code": "490245361",
            "country_code": "US",
            "telephone_number": "269-910-7327",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PATTERSON",
        "first_name": "BERNICE",
        "middle_name": "S",
        "credential": "LLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-16",
        "last_updated": "2021-04-30",
        "certification_date": "2021-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301015177",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6361007506",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2021; 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.