Bryan Lee Herder, O.T.

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

5201005556 Issued in MI

Practice address

7971 Moorsbridge Rd
Portage, MI 49024-4075

Phone

(269) 321-0929

Fax

(269) 321-1767

NPI assigned

May 2, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Specialty

Occupational Therapist in Private Practice

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Great Lakes Hand Therapy PCGroup PAC ID 0840109930, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Great Lakes Hand Therapy PC

  • Occupational Therapist
  • Portage, MI
  • NPI 1437378932
  Medicare reassignment Care Compare group NPD
• Great Lakes Hand Therapy PC

  • Occupational Therapist
  • Portage, MI
  • NPI 1073037313
  NPD Authorized official

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

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698105600000",
    "number": "1316169303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7971 MOORSBRIDGE RD",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490244075",
            "telephone_number": "269-321-0929",
            "fax_number": "269-321-1767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7971 MOORSBRIDGE RD",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490244075",
            "telephone_number": "269-321-0929",
            "fax_number": "269-321-1767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERDER",
        "first_name": "BRYAN",
        "middle_name": "LEE",
        "credential": "O.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-02",
        "last_updated": "2023-10-24",
        "certification_date": "2023-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MI",
            "license": "5201005556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapist in Portage, MI
• Providers in Portage, MI by specialty
• Occupational Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2023; 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.