Active NPI
Comprehensive Neuropsychological Services PC
- Clinical Neuropsychologist
- Portage, MI
National Provider Identifier
1740549120
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- 6301006050
- Legal business name
- COMPREHENSIVE NEUROPSYCHOLOGICAL SERVICES PC
- Practice address
- 7320 Garden LN
Portage, MI 49002-4423 - Phone
- (269) 217-2992
- Fax
- (269) 324-7707
- NPI assigned
- May 7, 2012
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Ennis Berker
- Title
- President
- Phone
- (269) 217-2992
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | 6301006050 | MI | Primary |
Addresses
Primary practice location
7320 Garden LN
Portage, MI 49002-4423
Mailing address
7320 Garden LN
Portage, MI 49002-4423
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0M0-9810 | Other | MI | MEDICARE PART B |
| 680C945730 | Other | MI | BLUE CROSS |
National Provider Directory
National Provider Directory- Tax ID family
- Comprehensive Neuropsy Chological Services PC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Community/Behavioral Health Agency
- Dexter, MI
- NPI 1053843003
Locations
7320 Garden Ln
Portage, MI 49002
Phone (269) 217-2992
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Clinical Neuropsychologist
- Dexter, MI
- NPI 1316039357
-
- Clinical Psychologist
- Saint Joseph, MI
- NPI 1548244635
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1336348800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1336348800000",
"number": "1740549120",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7320 GARDEN LN",
"city": "PORTAGE",
"state": "MI",
"postal_code": "490024423"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7320 GARDEN LN",
"city": "PORTAGE",
"state": "MI",
"postal_code": "490024423",
"telephone_number": "269-217-2992",
"fax_number": "269-324-7707"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COMPREHENSIVE NEUROPSYCHOLOGICAL SERVICES PC",
"organizational_subpart": "NO",
"enumeration_date": "2012-05-07",
"last_updated": "2012-05-07",
"status": "A",
"authorized_official_last_name": "BERKER",
"authorized_official_first_name": "ENNIS",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "269-217-2992",
"authorized_official_name_prefix": "Dr."
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Clinical Neuropsychologist",
"state": "MI",
"license": "6301006050",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PART B",
"identifier": "0M0-9810",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "680C945730",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portage, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.