Jeremy Adam Moeggenberg, PSYD.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301014926 Issued in MI

Practice address

400 S University Ave
Mt Pleasant, MI 48858-3170

Phone

(989) 317-3188

Fax

(989) 202-1888

NPI assigned

Aug 20, 2009

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

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, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

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 and National Provider Directory roles.

• Great Lakes Psychological Associates PLLC

  • Clinical Psychologist
  • Mt Pleasant, MI
  • NPI 1205205747
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1250726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546560000000",
    "number": "1558593707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 S UNIVERSITY AVE",
            "city": "MT PLEASANT",
            "state": "MI",
            "postal_code": "488583170",
            "telephone_number": "989-317-3188",
            "fax_number": "989-202-1888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 S UNIVERSITY AVE",
            "city": "MT PLEASANT",
            "state": "MI",
            "postal_code": "488583170",
            "telephone_number": "989-317-3188",
            "fax_number": "989-202-1888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOEGGENBERG",
        "first_name": "JEREMY",
        "middle_name": "ADAM",
        "name_prefix": "Dr.",
        "credential": "PSYD.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-08-20",
        "last_updated": "2019-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301014926",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cayla Mitzkovitz
• Mlwigren Consulting LLC
• MMH Counseling Services
• Carissa Moeggenberg, MA
• Forrie Ann Moeggenberg, LBSW
• Aaron John Moeggenborg
• Julia Mary Moeggenborg, LLBSW
• Joshua Michael Mogg
• Denelle Mohammed, MD
• Annu Mohan, M.D.

• Clinical Psychologist in Mt Pleasant, MI
• Providers in Mt Pleasant, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 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.