Cooper Brubacher, LLMSW

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

6801100374 Issued in MI

Practice address

704 Emmet St
Petoskey, MI 49770-2910

Phone

(231) 347-9880

NPI assigned

Mar 20, 2018

Sex

Male

Sole proprietor

No

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 Social Worker

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Old Town Psychological ServicesGroup PAC ID 2466600101, 8 clinicians

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.

• Old Town Psychological Services

  • Clinical Psychologist
  • Traverse City, MI
  • NPI 1093989162
  Medicare reassignment Care Compare group NPD
• Old Town Psychological Services-Gaylord

  • Clinical Child & Adolescent Psychologist
  • Gaylord, MI
  • NPI 1750659249
  NPD (past)

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

{
    "created_epoch": "1521504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521504000000",
    "number": "1669976189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "704 EMMET ST",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497702910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "704 EMMET ST",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497702910",
            "telephone_number": "231-347-9880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUBACHER",
        "first_name": "COOPER",
        "credential": "LLMSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-20",
        "last_updated": "2018-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MI",
            "license": "6801100374",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Esther Lee Brill, LLMSW
• Sarah Ann Broschart, RDN
• Kelli Marie Brower, PA-C
• Mary Lynn Elizabeth Brown, LMSW
• Tammy Broz, FNP-BC
• Alan August Budnick, MPT
• Shelley Lynne Budnick, PT
• Daniel Mark Buerkel, MD
• Victoria Buescher
• Heather Lynn Bur, NP-C

• Addiction (Substance Use Disorder) Counselor in Petoskey, MI
• Providers in Petoskey, MI by specialty
• Addiction (Substance Use Disorder) Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 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.