NPIMap

Organization Active NPI

Serenity Bay Health PLLC

  • Psychiatry Physician
  • Auburn, MI
National Provider Identifier
1497320451
Registry record updated Sep 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
SERENITY BAY HEALTH PLLC
Practice address
946 W Midland Rd
Auburn, MI 48611-9400
Phone
(989) 266-3188
Fax
(949) 561-5532
NPI assigned
May 23, 2021
Last updated
Sep 11, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2021

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

Authorized official

Name
Dr. Adam David Nicholas, MDNPI 1033309950
Title
Psychiatrist
Phone
(989) 266-3188

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
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

946 W Midland Rd
Auburn, MI 48611-9400

Mailing address

946 W Midland Rd
Auburn, MI 48611-9400
Phone (989) 266-3188

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210615002306 MI Part B Supplier - Clinic/Group Practice 3577963404 Receives reassigned benefits from 20 practitioners
Practice locations: Auburn, MI; Bay City, MI

National Provider Directory

National Provider Directory
Tax ID family
Serenity Bay Health PLLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

946 W Midland Rd
Auburn, MI 48611
Phone (989) 266-3188

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1621728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631318400000",
    "number": "1497320451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "946 W MIDLAND RD",
            "city": "AUBURN",
            "state": "MI",
            "postal_code": "486119400",
            "telephone_number": "989-266-3188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "946 W MIDLAND RD",
            "city": "AUBURN",
            "state": "MI",
            "postal_code": "486119400",
            "telephone_number": "989-266-3188",
            "fax_number": "949-561-5532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENITY BAY HEALTH PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-23",
        "last_updated": "2021-09-11",
        "certification_date": "2021-09-11",
        "status": "A",
        "authorized_official_last_name": "NICHOLAS",
        "authorized_official_first_name": "ADAM",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "PSYCHIATRIST",
        "authorized_official_telephone_number": "989-266-3188",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Auburn, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2021; 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.