NPIMap

Individual provider Active NPI

Biju Poulose, MD

  • Psychiatry Physician
  • Troy, MI
National Provider Identifier
1760876601
Registry record updated Jun 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
4301107319 Issued in MI
Practice address
2525 Crooks Rd Ste 100
Troy, MI 48084-4733
Phone
(248) 731-7305
Fax
(248) 731-7388
NPI assigned
Mar 27, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 24, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X 4301107319 MI Primary

Addresses

Primary practice location

2525 Crooks Rd Ste 100
Troy, MI 48084-4733

Mailing address

2525 Crooks Rd Ste 100
Troy, MI 48084-4733
Phone (248) 731-7305

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180613002022 MI Practitioner - PsychiatryPractitioner - Geriatric Psychiatry 1557663259 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
PsychiatryAlso: Geriatric Psychiatry
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Michigan Behavioral Medicine PLLCGroup PAC ID 8325069305, 24 clinicians

Practice addresses (Care Compare)

15160 Levan Rd
Livonia, MI 48154-5027
Phone (734) 953-9100

44405 Woodward Ave
Pontiac, MI 48341-5023
Phone (248) 858-3000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301107319MIMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Mary Mercy Physician Practices Single Specialty CurrentSince Oct 1, 2019 Accepting new patients
Iha Health Service Corporation CurrentSince Jul 1, 2023 Accepting new patients
St Joseph Mercy Hospital Single Specialty Current Accepting new patients
Iha Health Services Corporation Single Specialty Current Accepting new patients
Cognizance Behavioral Health PLLC Single Specialty Current Accepting new patients
St Joseph Mercy Hospital Single Specialty CurrentSince May 1, 2021 Accepting new patients
St Mary Mercy Physician Practices CurrentSince Oct 1, 2019 Accepting new patients
Iha Health Services Corporation Psychiatry CurrentSince Jul 1, 2023 Accepting new patients
St Joseph Mercy Hospital CurrentSince May 1, 2021 Accepting new patients

Locations

24 Frank Lloyd Wright Dr
Ann Arbor, MI 48105
Phone (734) 930-7400

2305 Genoa Business Park Dr
Ste 200
Brighton, MI 48114
Phone (810) 494-6840

19000 St Joes Pkwy
Ste 310
Livonia, MI 48152
Phone (248) 743-4490

36475 5 Mile Rd
Livonia, MI 48154
Phone (734) 464-4800

44405 Woodward Ave
Pontiac, MI 48341
Phone (248) 858-3000

44428 Woodward Ave
Ste 102
Pontiac, MI 48341
Phone (734) 712-8700

5361 McAuley Dr
Ypsilanti, MI 48197
Phone (734) 712-1300

Organizations & group practices 10

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1427414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561334400000",
    "number": "1760876601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2525 CROOKS RD STE 100",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480844733",
            "telephone_number": "248-731-7305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 CROOKS RD STE 100",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480844733",
            "telephone_number": "248-731-7305",
            "fax_number": "248-731-7388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POULOSE",
        "first_name": "BIJU",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-03-27",
        "last_updated": "2019-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "4301107319",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Troy, MI

Sources for this page

Verify at the official NPI Registry.