Active NPI
Mary Margaret Hillebrand, PHD
- Clinical Psychologist
- Southfield, MI
National Provider Identifier
1639288608
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301006954
- Practice address
- 27288 Apple Blossom Lane
Southfield, MI 48034-1048 - Phone
- (248) 355-4834
- Fax
- (248) 945-1002
- NPI assigned
- Aug 30, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6301006954 | MI | Primary |
Addresses
Primary practice location
27288 Apple Blossom Lane
Southfield, MI 48034-1048
Mailing address
27288 Apple Blossom Lane
Southfield, MI 48034-1048
Phone (248) 355-4834
Other identifiers 9
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 140832 | Other | MI | CARE CHOICE |
| 353123 | Other | MI | MHN |
| P1510923 | Other | MI | 1ST HEALTH |
| 5233178 | Other | MI | MAGELLAN |
| 043351 | Other | MI | VALUE OPTIONS |
| 680F33178 | Other | MI | BLUE CROSS |
| P1510923 | Other | MI | OXFORD HEALTH |
| 112243 | Other | MI | UNITED BEHAVIORAL HEALTH |
| 0005233178 | Other | MI | AETNA |
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100508000101 | MI | Practitioner - Clinical Psychologist | 8921136110 | Practice locations: Southfield, MI |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1639288608",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "27288 APPLE BLOSSOM LANE",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480341048",
"telephone_number": "248-355-4834",
"fax_number": "248-945-1002"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "27288 APPLE BLOSSOM LANE",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480341048",
"telephone_number": "248-355-4834",
"fax_number": "248-945-1002"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HILLEBRAND",
"first_name": "MARY",
"middle_name": "MARGARET",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-30",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301006954",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARE CHOICE",
"identifier": "140832",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MHN",
"identifier": "353123",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "1ST HEALTH",
"identifier": "P1510923",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN",
"identifier": "5233178",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "043351",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "680F33178",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD HEALTH",
"identifier": "P1510923",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED BEHAVIORAL HEALTH",
"identifier": "112243",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "0005233178",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Southfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.