Michiana Neuroscience, LLC

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

20042941A Issued in IN

Legal business name

MICHIANA NEUROSCIENCE, LLC

Doing business as

Michiana NeuroScience, LLC

Practice address

210 S Race St
Mishawaka, IN 46544-2032

Phone

(574) 229-9695

NPI assigned

Aug 24, 2018

Last updated

Aug 24, 2018By the provider in NPPES

Organization subpart

Yes

Parent organization

-As reported in NPPES

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

Authorized official

Name

Dr. Michael Richard Mitcheff, PSYDNPI 1649624735

Title

Director Psychology

Phone

(574) 229-9695

Specialties & licenses 1

Addresses

Other names 1

• Michiana NeuroScience, LLC Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Part of

Michiana Neuroscience LLC

Locations

Practitioners 5

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.

• Michael Richard Mitcheff, PSY.D.

  • Clinical Neuropsychologist
  • Mishawaka, IN
  • NPI 1649624735
  Medicare reassignment Care Compare group NPD Authorized official
• Lori Burrow, LCSW

  • Clinical Social Worker
  • Mishawaka, IN
  • NPI 1811715295
  Medicare reassignment Care Compare group NPD
• Jacquelyn Lamont

  • Clinical Social Worker
  • Mishawaka, IN
  • NPI 1811345408
  Medicare reassignment Care Compare group NPD
• Amy L Millard, NP

  • Nurse Practitioner
  • Michigan City, IN
  • NPI 1336455641
  Medicare reassignment Care Compare group
• Marvelyn Elfreda Thompson, NP

  • Family Nurse Practitioner
  • Berrien Springs, MI
  • NPI 1255901443

  IN

  Medicare reassignment NPD

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

{
    "created_epoch": "1535068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1535068800000",
    "number": "1750862959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 S RACE ST",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465442032",
            "telephone_number": "574-229-9695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 S RACE ST",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465442032",
            "telephone_number": "574-229-9695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIANA NEUROSCIENCE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "-",
        "enumeration_date": "2018-08-24",
        "last_updated": "2018-08-24",
        "status": "A",
        "authorized_official_last_name": "MITCHEFF",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "DIRECTOR PSYCHOLOGY",
        "authorized_official_telephone_number": "574-229-9695",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "IN",
            "license": "20042941A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Michiana NeuroScience, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinical Neuropsychologist in Mishawaka, IN
• Providers in Mishawaka, IN by specialty
• Clinical Neuropsychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2018; 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.