Rockford Psychological Services

Primary specialty

PsychologistTaxonomy code 103T00000X

License

6301006087 Issued in MI

Legal business name

ROCKFORD PSYCHOLOGICAL SERVICES

Practice address

16 North Monroe
Rockford, MI 49341

Phone

(616) 866-4830

Fax

(616) 866-4944

NPI assigned

Jan 19, 2011

Last updated

Feb 25, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Peter Jon Birkeland, PH.D.NPI 1245331149

Title

President

Phone

(616) 866-4830

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Practitioners 1

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.

• Peter J Birkeland, PHD

  • Clinical Psychologist
  • Rockford, MI
  • NPI 1245331149
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1295395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298592000000",
    "number": "1760787998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 NORTH MONROE",
            "city": "ROCKFORD",
            "state": "MI",
            "postal_code": "49341",
            "telephone_number": "616-866-4830",
            "fax_number": "616-866-4944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 NORTH MONROE",
            "city": "ROCKFORD",
            "state": "MI",
            "postal_code": "49341",
            "telephone_number": "616-866-4830",
            "fax_number": "616-866-4944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROCKFORD PSYCHOLOGICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-19",
        "last_updated": "2011-02-25",
        "status": "A",
        "authorized_official_last_name": "BIRKELAND",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "JON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "616-866-4830",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301006087",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Rockford, MI
• Providers in Rockford, MI by specialty
• Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2011; 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.