NPIMap

Organization Active NPI

Sandra Bowker and Associates, PLC

  • Clinical Neuropsychologist
  • Portage, MI
National Provider Identifier
1609021369
Registry record updated Nov 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
Legal business name
SANDRA BOWKER AND ASSOCIATES, PLC
Practice address
5930 Lovers LN
Second Floor
Portage, MI 49002-1673
Phone
(269) 343-3010
Fax
(269) 343-3017
NPI assigned
Nov 22, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2008

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

Authorized official

Name
Mrs. Stephanie Jean Stewart, MANPI 1386694909
Title
Practice Manager
Phone
(269) 343-3010

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical NeuropsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103G00000X Primary
Counseling PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC1900X

Addresses

Primary practice location

5930 Lovers LN
Second Floor
Portage, MI 49002-1673

Mailing address

5930 Lovers LN
Second Floor
Portage, MI 49002-1673
Phone (269) 343-3010

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090730000549 MI Part B Supplier - Clinic/Group Practice 4789737263 Receives reassigned benefits from 5 practitioners
Practice locations: Portage, MI

National Provider Directory

National Provider Directory

Locations

5930 Lovers Ln
Ste 2
Portage, MI 49002
Phone (269) 343-3010

5148 Lovers Ln
Ste 200
Portage, MI 49002
Phone (269) 343-3010

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1227312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1227312000000",
    "number": "1609021369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5930 LOVERS LN",
            "address_2": "SECOND FLOOR",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490021673",
            "telephone_number": "269-343-3010",
            "fax_number": "269-343-3017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5930 LOVERS LN",
            "address_2": "SECOND FLOOR",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490021673",
            "telephone_number": "269-343-3010",
            "fax_number": "269-343-3017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANDRA BOWKER AND ASSOCIATES, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-22",
        "last_updated": "2008-11-22",
        "status": "A",
        "authorized_official_last_name": "STEWART",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "269-343-3010",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portage, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2008; 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.