NPIMap

Organization Active NPI

Michigan Psychiatric & Primary Care Clinic, PC

  • Clinic/Center
  • East Lansing, MI
National Provider Identifier
1295383909
Registry record updated Jan 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
MICHIGAN PSYCHIATRIC & PRIMARY CARE CLINIC, PC
Practice address
702 W Lake Lansing Rd
East Lansing, MI 48823-8526
Phone
(517) 332-5342
NPI assigned
Aug 27, 2019
Last updated
Jan 3, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2024

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

Authorized official

Name
Tham N Doan, NPNPI 1861986853
Title
Manager
Phone
(517) 332-5342

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary
Adult Mental Health Clinic/Center 261QM0850X
Adolescent and Children Mental Health Clinic/Center 261QM0855X
Primary Care Clinic/Center 261QP2300X

Addresses

Primary practice location

702 W Lake Lansing Rd
East Lansing, MI 48823-8526

Mailing address

702 W Lake Lansing Rd
East Lansing, MI 48823-8526
Phone (517) 332-5342

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191220002006 MI Part B Supplier - Clinic/Group Practice 4688008873 Receives reassigned benefits from 16 practitioners
1 other NPI on this enrollment
Practice locations: East Lansing, MI

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D2235797Michigan Psychiatric and Primary Care Clinic P C702 W Lake Lansing Road, East Lansing, MI 48823Provider-performed microscopySep 12, 2027

National Provider Directory

National Provider Directory

Locations

6110 Abbott Rd
East Lansing, MI 48823
Phone (517) 332-5342

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1566864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704240000000",
    "number": "1295383909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 W LAKE LANSING RD",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488238526",
            "telephone_number": "517-332-5342",
            "fax_number": "517-316-2893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 W LAKE LANSING RD",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488238526",
            "telephone_number": "517-332-5342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIGAN PSYCHIATRIC & PRIMARY CARE CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-27",
        "last_updated": "2024-01-03",
        "certification_date": "2023-07-12",
        "status": "A",
        "authorized_official_last_name": "DOAN",
        "authorized_official_first_name": "THAM",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "517-332-5342",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Lansing, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.