NPIMap

Organization Active NPI

Reliance Community Care Partners

Doing business as Reliance Integrated Wellness Center

  • Psychiatry Physician
  • Grand Rapids, MI
National Provider Identifier
1861045775
Registry record updated Sep 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
RELIANCE COMMUNITY CARE PARTNERS
Doing business as
Reliance Integrated Wellness Center
Practice address
2100 Raybrook St SE Ste 100
Grand Rapids, MI 49546-5782
Phone
(616) 954-1555
Fax
(616) 954-1520
NPI assigned
Jul 19, 2019
Last updated
Sep 14, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
RELIANCE COMMUNITY CARE PARTNERSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 14, 2021

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

Authorized official

Name
Deborah M Mathesonnorthern, ABA
Title
Billing Specialist
Phone
(616) 954-1518

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary
Geriatric Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0805X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X

Addresses

Primary practice location

2100 Raybrook St SE Ste 100
Grand Rapids, MI 49546-5782

Mailing address

2100 Raybrook St SE Ste 203
Grand Rapids, MI 49546-5783
Phone (616) 954-1518

Other names 2

  • Reliance Integrated Wellness Center Doing business as
  • HHS Health Options Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120329000559 MI Part B Supplier - Clinic/Group Practice 8921268855 Receives reassigned benefits from 12 practitioners
1 other NPI on this enrollment
Practice locations: Grand Rapids, MI

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Reliance Community Partners

Locations

2100 Raybrook St SE
Ste 203
Grand Rapids, MI 49546
Phone (616) 954-1518

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1563494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631577600000",
    "number": "1861045775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 RAYBROOK ST SE STE 203",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495465783",
            "telephone_number": "616-954-1518",
            "fax_number": "616-954-1520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 RAYBROOK ST SE STE 100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495465782",
            "telephone_number": "616-954-1555",
            "fax_number": "616-954-1520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RELIANCE COMMUNITY CARE PARTNERS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RELIANCE COMMUNITY CARE PARTNERS",
        "enumeration_date": "2019-07-19",
        "last_updated": "2021-09-14",
        "certification_date": "2021-09-14",
        "status": "A",
        "authorized_official_last_name": "MATHESONNORTHERN",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "BILLING SPECIALIST",
        "authorized_official_telephone_number": "616-954-1518",
        "authorized_official_credential": "ABA"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0805X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Reliance Integrated Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "HHS Health Options",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2021; 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.