NPIMap

Organization Active NPI

State Street Behavioral Services

  • Psychiatric/Mental Health Nurse Practitioner
  • Saginaw, MI
National Provider Identifier
1265050793
Registry record updated Mar 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
STATE STREET BEHAVIORAL SERVICES
Practice address
4055 State St
Saginaw, MI 48603-4069
Phone
(989) 270-1749
NPI assigned
Jul 10, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2024

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

Authorized official

Name
Abraham K Kimeli, NPNPI 1215404413
Title
Owner
Phone
(989) 270-1749

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
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

4055 State St
Saginaw, MI 48603-4069

Mailing address

4055 State St
Saginaw, MI 48603-4069
Phone (989) 270-1749

Other practice location 1

4713 State St
Saginaw, MI 48603-3808
Phone (989) 930-8558

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201002000065 MI Part B Supplier - Clinic/Group Practice 5698194173 Receives reassigned benefits from 3 practitioners
Practice locations: Saginaw, MI

National Provider Directory

National Provider Directory

Locations

4055 State St
Saginaw, MI 48603
Phone (989) 270-1749

4055 State St
Ste B
Saginaw, MI 48603
Phone (989) 270-1749

4713 State St
Saginaw, MI 48603
Phone (989) 270-1749

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1594339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709337600000",
    "number": "1265050793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4055 STATE ST",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486034069",
            "telephone_number": "989-270-1749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4055 STATE ST",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486034069",
            "telephone_number": "989-270-1749"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4713 State St",
            "address_purpose": "LOCATION",
            "city": "Saginaw",
            "state": "MI",
            "postal_code": "486033808",
            "country_code": "US",
            "telephone_number": "989-930-8558",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "STATE STREET BEHAVIORAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-10",
        "last_updated": "2024-03-02",
        "certification_date": "2024-03-02",
        "status": "A",
        "authorized_official_last_name": "KIMELI",
        "authorized_official_first_name": "ABRAHAM",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "989-270-1749",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saginaw, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2024; 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.