NPIMap

Organization Active NPI

Mid-America Psychological Services, P. C.

  • Clinical Social Worker
  • Portage, MI
National Provider Identifier
1376682641
Registry record updated Sep 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
071800 Issued in MI
Legal business name
MID-AMERICA PSYCHOLOGICAL SERVICES, P. C.
Practice address
8036 Moors Bridge Rd
Suite 2
Portage, MI 49024-4419
Phone
(269) 327-1438
Fax
(269) 327-6454
NPI assigned
Feb 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2025

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

Authorized official

Name
Mr. Charles Clearwater, LMSWNPI 1790134740
Title
Owner/President
Phone
(269) 744-6138

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
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 071800 MI Primary

Addresses

Primary practice location

8036 Moors Bridge Rd
Suite 2
Portage, MI 49024-4419

Mailing address

8036 Moorsbridge Rd
Suite 2
Portage, MI 49024
Phone (269) 327-1438

Other identifiers 1

IdentifierTypeStateIssuer
800C962000OtherMABLUE CROSS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040415000412 MI Part B Supplier - Clinic/Group Practice 1759374812 Receives reassigned benefits from 11 practitioners
Practice locations: Portage, MI

National Provider Directory

National Provider Directory

Locations

8036 Moorsbridge Rd
Ste 2
Portage, MI 49024
Phone (269) 327-1438

Practitioners & affiliated clinicians

Practitioners 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759104000000",
    "number": "1376682641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8036 MOORSBRIDGE RD",
            "address_2": "SUITE 2",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "49024",
            "telephone_number": "269-327-1438",
            "fax_number": "269-327-6454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8036 MOORS BRIDGE RD",
            "address_2": "SUITE 2",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490244419",
            "telephone_number": "269-327-1438",
            "fax_number": "269-327-6454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-AMERICA PSYCHOLOGICAL SERVICES, P. C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-05",
        "last_updated": "2025-09-29",
        "certification_date": "2025-09-29",
        "status": "A",
        "authorized_official_last_name": "CLEARWATER",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "269-744-6138",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LMSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "071800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "800C962000",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portage, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2025; 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.