Active NPI
Polly Gipson, PH.D.
- Clinical Psychologist
- Ann Arbor, MI
National Provider Identifier
1235440462
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301014587
- Practice address
- 4250 Plymouth Road
Ann Arbor, MI 48109-2700 - Phone
- (734) 764-6443
- Fax
- (734) 763-5580
- NPI assigned
- Jun 22, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6301014587 | MI | Primary |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 6301013968 | MI |
Addresses
Primary practice location
4250 Plymouth Road
Ann Arbor, MI 48109-2700
Mailing address
3621 South State Street
700 KMS Place
Ann Arbor, MI 48108
Phone (734) 936-2047
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301013968 | MI | MD | Clinical Child & Adolescent Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Regents of the University of Michigan | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Acute Care Hospital
- Ann Arbor, MI
- NPI 1003878539
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1277164800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1364256000000",
"number": "1235440462",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3621 SOUTH STATE STREET",
"address_2": "700 KMS PLACE",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "48108",
"telephone_number": "734-936-2047"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4250 PLYMOUTH ROAD",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481092700",
"telephone_number": "734-764-6443",
"fax_number": "734-763-5580"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIPSON",
"first_name": "POLLY",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-06-22",
"last_updated": "2013-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301014587",
"primary": true
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "MI",
"license": "6301013968",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ann Arbor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.