Terry L Braciszewski, PH.D,

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301006431 Issued in MI

Practice address

7926 Ann Arbor St
Dexter, MI 48130-1344

Phone

(734) 320-2497

Fax

(810) 231-0771

NPI assigned

Aug 12, 2006

Last updated

Aug 26, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 6

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Beaver Island Rural Health CenterGroup PAC ID 3971539156, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Beaver Island Rural Health Center

  • Rural Health Clinic/Center
  • Beaver Island, MI
  • NPI 1407828080
  Medicare reassignment Care Compare group NPD
• Momentum Rehab LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Dexter, MI
  • NPI 1295125250
  Authorized official Same address or phone
• Momentum Rehabilitation Services, Inc.

  • Clinical Neuropsychologist
  • Dexter, MI
  • NPI 1730308115
  Authorized official Same address or phone

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

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566777600000",
    "number": "1386656023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224 W SIBLEY ST",
            "city": "HOWELL",
            "state": "MI",
            "postal_code": "488432221",
            "telephone_number": "734-320-2497",
            "fax_number": "810-231-0771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7926 ANN ARBOR ST",
            "city": "DEXTER",
            "state": "MI",
            "postal_code": "481301344",
            "telephone_number": "734-320-2497",
            "fax_number": "810-231-0771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRACISZEWSKI",
        "first_name": "TERRY",
        "middle_name": "L",
        "credential": "PH.D,",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-12",
        "last_updated": "2019-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301006431",
            "primary": true
        },
        {
            "code": "103TH0100X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health Service",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "MI",
            "license": "6301006431",
            "primary": false
        },
        {
            "code": "103TR0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACS/OWCP",
            "identifier": "610093200",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "680H146930",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marcia Aileen Bockbrader, MD PHD
• Margaret Mary Bouwkamp, SLP
• Boyce DC PLLC
• Alan Stephen Boyce, DC
• Julie Ann Boyd, M.A.,L.P.C.
• Jaime Brenay
• Jenna Marie Brooks
• Keshara Diamond Brown, SW
• Julie Anne Bumpus X, FNP-BC
• Thomas Joseph Burke, DDS

• Clinical Psychologist in Dexter, MI
• Providers in Dexter, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.