NPIMap

Organization Active NPI

Behavioral Medicine Associates of Mid Michigan PC

  • Clinical Psychologist
  • Midland, MI
National Provider Identifier
1740370089
Registry record updated Dec 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
BEHAVIORAL MEDICINE ASSOCIATES OF MID MICHIGAN PC
Practice address
1205 E Wackerly St
Midland, MI 48642-7035
Phone
(989) 832-9161
Fax
(989) 832-8813
NPI assigned
Oct 16, 2006
Last updated
Dec 4, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2014

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

Authorized official

Name
Dr. Lynn Elaine Simons, PSY.D.NPI 1457321291
Title
Director
Phone
(989) 832-9161

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X NU Primary

Addresses

Primary practice location

1205 E Wackerly St
Midland, MI 48642-7035

Mailing address

1205 E Wackerly St
Midland, MI 48642-7035
Phone (989) 832-9161

Other identifiers 1

IdentifierTypeStateIssuer
0P36530OtherMEDICARE PTAN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061030000422 MI Part B Supplier - Clinic/Group Practice 6103823406 Receives reassigned benefits from 8 practitioners
Practice locations: Midland, MI

National Provider Directory

National Provider Directory

Locations

1108 Ashman St
Midland, MI 48640
Phone (989) 832-4000

1205 E Wackerly St
Midland, MI 48642
Phone (989) 832-4000

115 S Franklin St
Mt Pleasant, MI 48858
Phone (989) 773-0102

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417651200000",
    "number": "1740370089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 E WACKERLY ST",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486427035",
            "telephone_number": "989-832-9161",
            "fax_number": "989-832-8813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 E WACKERLY ST",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486427035",
            "telephone_number": "989-832-9161",
            "fax_number": "989-832-8813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEHAVIORAL MEDICINE ASSOCIATES OF MID MICHIGAN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-16",
        "last_updated": "2014-12-04",
        "status": "A",
        "authorized_official_last_name": "SIMONS",
        "authorized_official_first_name": "LYNN",
        "authorized_official_middle_name": "ELAINE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "989-832-9161",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "0P36530",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Midland, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2014; 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.