NPIMap

Organization Active NPI

Geriatric Psychiatric Services PLLC

  • Adult Development & Aging Psychologist
  • Maumee, OH
National Provider Identifier
1467492173
Registry record updated Jul 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Development & Aging PsychologistTaxonomy code 103TA0700X
Legal business name
GERIATRIC PSYCHIATRIC SERVICES PLLC
Practice address
1715 Indian Wood Cir Ste 200
Maumee, OH 43537-4055
Phone
(877) 906-9699
NPI assigned
Jun 8, 2006
Last updated
Jul 1, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2025

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

Authorized official

Name
Robert A Clemente
Title
Manager
Phone
(586) 620-8100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Development & Aging Psychologist 103TA0700X NU Primary

Addresses

Primary practice location

1715 Indian Wood Cir Ste 200
Maumee, OH 43537-4055

Mailing address

39465 W 14 Mile Rd
Novi, MI 48377-1600
Phone (248) 859-3900

Other identifiers 1

IdentifierTypeStateIssuer
260F340040OtherMIBCBS PHYSICIAN GROUP

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101028000065 OH Part B Supplier - Clinic/Group Practice 6204837388 Receives reassigned benefits from 16 practitioners
Practice locations: Leipsic, OH; Whitehouse, OH; Waterville, OH; Oak Harbor, OH; Maumee, OH; Lima, OH; Kalida, OH; Delta, OH…

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

30781 Stephenson Hwy
#967
Madison Heights, MI 48071

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751328000000",
    "number": "1467492173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39465 W 14 MILE RD",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483771600",
            "telephone_number": "248-859-3900",
            "fax_number": "888-483-0118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1715 INDIAN WOOD CIR STE 200",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435374055",
            "telephone_number": "877-906-9699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GERIATRIC PSYCHIATRIC SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-08",
        "last_updated": "2025-07-01",
        "certification_date": "2025-07-01",
        "status": "A",
        "authorized_official_last_name": "CLEMENTE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "586-620-8100"
    },
    "taxonomies": [
        {
            "code": "103TA0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Adult Development & Aging",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PHYSICIAN GROUP",
            "identifier": "260F340040",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Maumee, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 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.