Individual provider Active NPI

Elise Kay Hodges, PHD

  • Clinical Psychologist
  • Ann Arbor, MI
National Provider Identifier
1780797621
Registry record updated Jun 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
6301012527 Issued in MI
Practice address
2101 Commonwealth
Ann Arbor, MI 48105-2969
Phone
(800) 525-5188
NPI assigned
Aug 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X 6301012527 MI
Clinical Psychologist 103TC0700X 6301012527 MI Primary

Addresses

Primary practice location

2101 Commonwealth
Ann Arbor, MI 48105-2969

Mailing address

3621 S State St
Ann Arbor, MI 48108-1633
Phone (734) 647-5299

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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 1

Enrollment IDStateProvider typePAC IDDetails
I20070306000376 MI Practitioner - Clinical Psychologist 7719080183 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
6301012527MIMDClinical Neuropsychologist

Organizations & group practices 1

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": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559779200000",
    "number": "1780797621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 S STATE ST",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481081633",
            "telephone_number": "734-647-5299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 COMMONWEALTH",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481052969",
            "telephone_number": "800-525-5188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HODGES",
        "first_name": "ELISE",
        "middle_name": "KAY",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-16",
        "last_updated": "2019-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "MI",
            "license": "6301012527",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301012527",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

Verify at the official NPI Registry.