NPIMap

Organization Active NPI

Optimum Balance

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fenton, MI
National Provider Identifier
1245767888
Registry record updated Sep 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
6401013238 Issued in MI
Legal business name
OPTIMUM BALANCE
Practice address
1537 N. Leroy Street
Suite D
Fenton, MI 48430
Phone
(810) 771-8969
NPI assigned
May 14, 2017
Last updated
Sep 17, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2020

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

Authorized official

Name
Karl Stanley GillNPI 1447503651
Title
Owner
Phone
(810) 771-8969

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
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 6401013238 MI Primary

Addresses

Primary practice location

1537 N. Leroy Street
Suite D
Fenton, MI 48430

Mailing address

1537 N Leroy St Ste D
Fenton, MI 48430-2795
Phone (810) 771-8969

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190906003138 MI Part B Supplier - Clinic/Group Practice 9739418351 Receives reassigned benefits from 10 practitioners
Practice locations: Fenton, MI

National Provider Directory

National Provider Directory

Locations

1537 N Leroy St
Ste D
Fenton, MI 48430
Phone (810) 771-8969

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1494720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600300800000",
    "number": "1245767888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1537 N LEROY ST STE D",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "484302795",
            "telephone_number": "810-771-8969",
            "fax_number": "844-558-9767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1537 N. LEROY STREET",
            "address_2": "SUITE D",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "48430",
            "telephone_number": "810-771-8969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMUM BALANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-14",
        "last_updated": "2020-09-17",
        "certification_date": "2020-09-17",
        "status": "A",
        "authorized_official_last_name": "GILL",
        "authorized_official_first_name": "KARL",
        "authorized_official_middle_name": "STANLEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "810-771-8969"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "MI",
            "license": "6401013238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fenton, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 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.