Individual provider Active NPI

Sukhvender K Nijjer, PH.D.

  • Clinical Psychologist
  • Okemos, MI
National Provider Identifier
1821068693
Registry record updated May 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
6301009849 Issued in MI
Practice address
4129 Okemos Rd
Suite 6
Okemos, MI 48864-2822
Phone
(517) 999-3171
NPI assigned
Jan 25, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 22, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 6301009849 MI Primary

Addresses

Primary practice location

4129 Okemos Rd
Suite 6
Okemos, MI 48864-2822

Mailing address

PO Box 10
Mason, MI 48854-0010

Other identifiers 3

IdentifierTypeStateIssuer
26OC311520OtherMIBCBS PROVIDER
255686000OtherMIMAGELLAN PROVIDER
7156410OtherMIAETNA PROVIDER

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
I20070604000204 MI Practitioner - Clinical Psychologist 0446358113 Practice locations: Okemos, MI

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4129 Okemos Rd
Suite 6
Okemos, MI 48864-2821
Phone (517) 999-3171

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
6301009849MIMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
VLSR Madireddy MD PC CurrentSince May 26, 2024 Accepting new patients

Locations

4129 Okemos Rd
Ste 6
Okemos, MI 48864
Phone (517) 803-4544

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": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716336000000",
    "number": "1821068693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10",
            "city": "MASON",
            "state": "MI",
            "postal_code": "488540010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4129 OKEMOS RD",
            "address_2": "SUITE 6",
            "city": "OKEMOS",
            "state": "MI",
            "postal_code": "488642822",
            "telephone_number": "517-999-3171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIJJER",
        "first_name": "SUKHVENDER",
        "middle_name": "K",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-01-25",
        "last_updated": "2024-05-22",
        "certification_date": "2024-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301009849",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER",
            "identifier": "26OC311520",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN PROVIDER",
            "identifier": "255686000",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER",
            "identifier": "7156410",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Okemos, MI

Sources for this page

Verify at the official NPI Registry.