Active NPI
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- Behavior Technician
- Saginaw, MI
National Provider Identifier
1700459351
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 1300 N Michigan Ave
Saginaw, MI 48602-4732 - Phone
- (989) 401-9033
- NPI assigned
- Jul 21, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Technician | 247200000X | MI | ||
| Community Health Clinic/Center | 261QC1500X | 1689233579 | NV | |
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
1300 N Michigan Ave
Saginaw, MI 48602-4732
Mailing address
429 Romain Rd
Caro, MI 48723-9302
Phone (586) 746-7445
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1689233579 | NV | MD | Community Health Clinic/Center |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1626825600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1672185600000",
"number": "1700459351",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "429 ROMAIN RD",
"city": "CARO",
"state": "MI",
"postal_code": "487239302",
"telephone_number": "586-746-7445"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1300 N MICHIGAN AVE",
"city": "SAGINAW",
"state": "MI",
"postal_code": "486024732",
"telephone_number": "989-401-9033"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BANNER",
"first_name": "REED",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-07-21",
"last_updated": "2022-12-28",
"certification_date": "2022-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": "MI",
"license": null,
"primary": false
},
{
"code": "261QC1500X",
"taxonomy_group": "",
"desc": "Clinic/Center, Community Health",
"state": "NV",
"license": "1689233579",
"primary": false
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saginaw, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.