Active NPI
Bruce Edward Malcolm, PSYD
- Clinical Psychologist
- Medina, OH
National Provider Identifier
1740480755
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 7105
- Practice address
- 3593 Medina Rd # 181
Medina, OH 44256-8182 - Phone
- (330) 401-5244
- NPI assigned
- Jul 19, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 7105 | OH | Primary |
Addresses
Primary practice location
3593 Medina Rd # 181
Medina, OH 44256-8182
Mailing address
2121 Kevin CT NE
New Philadelphia, OH 44663-9446
Phone (330) 401-5244
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 680H215160 | Other | MI | BC/BS OF MICHIGAN |
| 3218695674 | Other | MI | PPOM |
| 382695674 | Other | MI | VALUE OPTIONS |
| 371354712 | Other | MI | MAGELLAN |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7105 | OH | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184803200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1648512000000",
"number": "1740480755",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2121 KEVIN CT NE",
"city": "NEW PHILADELPHIA",
"state": "OH",
"postal_code": "446639446",
"telephone_number": "330-401-5244"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3593 MEDINA RD # 181",
"city": "MEDINA",
"state": "OH",
"postal_code": "442568182",
"telephone_number": "330-401-5244"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALCOLM",
"first_name": "BRUCE",
"middle_name": "EDWARD",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-07-19",
"last_updated": "2022-03-29",
"certification_date": "2022-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OH",
"license": "7105",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS OF MICHIGAN",
"identifier": "680H215160",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PPOM",
"identifier": "3218695674",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "382695674",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN",
"identifier": "371354712",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Medina, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 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.