Individual provider Active NPI

Thomas Ward Bishop, PSY D

  • Clinical Psychologist
  • Chelsea, MI
National Provider Identifier
1760480966
Registry record updated Jun 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
6301017038 Issued in MI
Practice address
14700 East Old US 12
Chelsea, MI 48118-1185
Phone
(734) 475-1321
NPI assigned
Jul 12, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2017

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X P2573 TN
Family Psychologist 103TF0000X 6301017038 MI
Clinical Psychologist 103TC0700X 6301017038 MI Primary

Addresses

Primary practice location

14700 East Old US 12
Chelsea, MI 48118-1185

Mailing address

3621 South State Street
700 KMS Place
Ann Arbor, MI 48108
Phone (734) 936-2047

Other identifiers 1

IdentifierTypeStateIssuer
3980983MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, MI2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040806001056 TN Practitioner - Clinical Psychologist 1557333986 Reassigns benefits to 2 organizations
I20170531000377 MI Practitioner - Clinical Psychologist 1557333986 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Erlanger HealthGroup PAC ID 1153780226, 504 clinicians

Practice addresses (Care Compare)

1100 E 3Rd St
Chattanooga, TN 37403-2241
Phone (423) 778-8837

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2573TNMDProfessional Counselor
P2573TNMDClinical Psychologist
1058KSMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
Erlanger Health CurrentSince Apr 15, 2024 Accepting new patients
Medical Education Assistance Corporation CurrentSince Mar 19, 2012 Accepting new patients
Erlanger Health CurrentSince Apr 15, 2024 Accepting new patients
Prairie View, Inc. Past Accepting new patients
Prairie View, Inc. PastSince Aug 1, 1996 Accepting new patients

Locations

1100 E 3rd St
Chattanooga, TN 37403
Phone (423) 778-2957

222 E Main St
Johnson City, TN 37604
Phone (423) 433-6200

2600 Taft Hwy
Ste 100
Signal Mtn, TN 37377
Phone (423) 778-9434

6350 W Andrew Johnson Hwy
Talbott, TN 37877
Phone (423) 586-5031

6350 W Andrew Johnson Hwy
#100
Talbott, TN 37877
Phone (423) 586-5031

Organizations & group practices 6

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

NPI Registry JSON

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

{
    "created_epoch": "1121126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1496966400000",
    "number": "1760480966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 SOUTH STATE STREET",
            "address_2": "700 KMS PLACE",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "48108",
            "telephone_number": "734-936-2047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14700 EAST OLD US 12",
            "city": "CHELSEA",
            "state": "MI",
            "postal_code": "481181185",
            "telephone_number": "734-475-1321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BISHOP",
        "first_name": "THOMAS",
        "middle_name": "WARD",
        "credential": "PSY D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-12",
        "last_updated": "2017-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TN",
            "license": "P2573",
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "",
            "desc": "Psychologist, Family",
            "state": "MI",
            "license": "6301017038",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301017038",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3980983",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chelsea, MI

Sources for this page

Verify at the official NPI Registry.