Active NPI
Bruce Hamby
- Physician Assistant
- Clarkston, MI
National Provider Identifier
1295318376
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 5601010393
- Practice address
- 5715 Bella Rosa Blvd Ste 200
Clarkston, MI 48348-4776 - Phone
- (248) 922-4900
- NPI assigned
- May 5, 2021
- Last updated
- May 5, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5601010393 | MI | Primary |
Addresses
Primary practice location
5715 Bella Rosa Blvd Ste 200
Clarkston, MI 48348-4776
Mailing address
5715 Bella Rosa Blvd Ste 200
Clarkston, MI 48348-4776
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 1, 2023 through Apr 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601010393 | MI | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1620172800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620172800000",
"number": "1295318376",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5715 BELLA ROSA BLVD STE 200",
"city": "CLARKSTON",
"state": "MI",
"postal_code": "483484776"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5715 BELLA ROSA BLVD STE 200",
"city": "CLARKSTON",
"state": "MI",
"postal_code": "483484776",
"telephone_number": "248-922-4900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAMBY",
"first_name": "BRUCE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-05-05",
"last_updated": "2021-05-05",
"certification_date": "2021-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MI",
"license": "5601010393",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clarkston, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.