Tiffany Ann Bruckner, D.O.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

5101021660 Issued in MI

Practice address

25319 Little Mack Ave
Saint Clair Shores, MI 48081-3370

Phone

(586) 443-4950

NPI assigned

May 19, 2015

Sex

Female

Sole proprietor

Yes

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: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tiffany.chritz.3@8209.direct.athenahealth.com
• Direct secure messaging: tbruckner1119205@direct.hfhs.org
• FHIR API: https://fhir-myrecord.cerner.com/r4/mQjCqHb5rkr1u1foU4dqhQPBpi7Qk9R4/

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Seton Health Corporation of Southeastern Michigan

  • Family Medicine Physician
  • Clinton Township, MI
  • NPI 1598177065
  Medicare reassignment NPD
• Seton Health Corporation of Southeastern Michigan

  dba Seton Medical Group Inc

  • Physical Therapy Clinic/Center
  • Macomb, MI
  • NPI 1487067260
  NPD
• Ascension Macomb Oakland Hospital

  dba Michigan Neuro-Ophthalmology & Oculoplastic Surgery

  • Ophthalmology Physician
  • Madison Heights, MI
  • NPI 1114962461
  NPD (past)
• Henry Ford Cornerstone Medical Group

  • Family Medicine Physician
  • Clinton Township, MI
  • NPI 1851765374
  NPD (past)
• Thomas D Schomaker DO PC

  • Pediatrics Physician
  • Clinton Township, MI
  • NPI 1497906499
  NPD (past)

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

{
    "created_epoch": "1431993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682899200000",
    "number": "1750760070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25319 LITTLE MACK AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480813370",
            "telephone_number": "586-443-4950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25319 LITTLE MACK AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480813370",
            "telephone_number": "586-443-4950"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "36075 Utica Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Clinton Township",
            "state": "MI",
            "postal_code": "480351061",
            "country_code": "US",
            "telephone_number": "586-741-0430",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRUCKNER",
        "first_name": "TIFFANY",
        "middle_name": "ANN",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-05-19",
        "last_updated": "2023-05-01",
        "certification_date": "2023-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "5101021660",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Lynn Brock, M.P.T.
• Mira J Brooks, AU.D. CCC-A
• Mahogany Brown
• Jasmine Browning
• William Brownscombe
• Anthony Paul Brunetti, PA-C
• Shawndelin Marie Brunsman, P.A.-C
• Bryan a. Baetens, D.C., P.C. (Baetens Chiropractic Center)
• Adele Buck, BCBA, MA, LBA
• Lynette Cynthia Buckner, R.N.

• Pediatrics Physician in Saint Clair Shores, MI
• Providers in Saint Clair Shores, MI by specialty
• Pediatrics Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.