Brent Roderick Smith, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301008782 Issued in MI

Practice address

6692 Spring Arbor Rd
Jackson, MI 49201

Phone

(517) 750-3869

Fax

(517) 750-3869

NPI assigned

Aug 19, 2006

Last updated

Aug 17, 2018By 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 1

Addresses

Other identifiers 1

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, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

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

• Arbor Hills Psychological Services PLLC

  dba Seeds to Sprouts

  • Clinical Psychologist
  • Jackson, MI
  • NPI 1750579629
  Medicare reassignment NPD

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

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534464000000",
    "number": "1558475012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6692 SPRING ARBOR RD",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492019322",
            "telephone_number": "517-750-3869",
            "fax_number": "517-750-3673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6692 SPRING ARBOR RD",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "49201",
            "telephone_number": "517-750-3869",
            "fax_number": "517-750-3869"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "818 Winifred St",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MI",
            "postal_code": "492023062",
            "country_code": "US",
            "telephone_number": "517-513-3617",
            "fax_number": "517-796-3104",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "BRENT",
        "middle_name": "RODERICK",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-19",
        "last_updated": "2018-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301008782",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD MI",
            "identifier": "680C845330",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patrick Richard Smarch, DC
• Kendra Lynn Smiatowicz, OTR/L
• Smiles on Wheels
• Smiles on Wheels
• Abigail Susan Smith, MD
• Channing Marshall Smith, M.D.
• Charity Smith
• Constance Elizabeth Smith, D.D.S.
• Destiny Lynn Madison Smith
• Elizabeth Lee-Smith Smith, MSW

• Clinical Psychologist in Jackson, MI
• Providers in Jackson, 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 17, 2018; 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.