NPIMap

Organization Active NPI

Integral Health Psychology Services, PC

  • Psychologist
  • Muncie, IN
National Provider Identifier
1851421929
Registry record updated Jul 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
20041132A Issued in IN
Legal business name
INTEGRAL HEALTH PSYCHOLOGY SERVICES, PC
Practice address
605 S Miramar Way
Muncie, IN 47304-6723
Phone
(765) 281-1442
NPI assigned
Mar 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2013

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

Authorized official

Name
Dr. Daniel John Broderick, PHDNPI 1366635518
Title
President
Phone
(765) 808-1687

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X 20041132A IN Primary

Addresses

Primary practice location

605 S Miramar Way
Muncie, IN 47304-6723

Mailing address

605 S Miramar Way
Muncie, IN 47304-6723
Phone (765) 281-1442

Other identifiers 4

IdentifierTypeStateIssuer
837986000OtherINMAGELLAN HEALTH SERVICES
000000371406OtherINANTHEM BLUE CROSS
200532030AMedicaidIN
000000028559OtherINM-PLAN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372636800000",
    "number": "1851421929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 S MIRAMAR WAY",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473046723",
            "telephone_number": "765-281-1442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 S MIRAMAR WAY",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473046723",
            "telephone_number": "765-281-1442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRAL HEALTH PSYCHOLOGY SERVICES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2013-07-01",
        "status": "A",
        "authorized_official_last_name": "BRODERICK",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "765-808-1687",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "IN",
            "license": "20041132A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN HEALTH SERVICES",
            "identifier": "837986000",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS",
            "identifier": "000000371406",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200532030A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "M-PLAN",
            "identifier": "000000028559",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Muncie, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.