Individual provider Active NPI

Arthur Kupersmith, PHD., HSPP

  • Clinical Psychologist
  • Marion, IN
National Provider Identifier
1861505059
Registry record updated Jan 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
LIC20090165A Issued in IN
Practice address
101 S Washington St
Marion, IN 46952-3867
Phone
(765) 662-9971
Fax
(765) 651-6556
NPI assigned
Aug 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2016

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Psychologist 103TH0100X
Psychologist 103T00000X
Clinical Psychologist 103TC0700X LIC20090165A IN Primary
Counseling Psychologist 103TC1900X LIC20090165A IN

Addresses

Primary practice location

101 S Washington St
Marion, IN 46952-3867

Mailing address

101 S Washington St
Marion, IN 46952-3867
Phone (765) 662-9971

Other identifiers 9

IdentifierTypeStateIssuer
100123560AMedicaidIN
000000317611OtherINANTHEM
4027OtherINMPLAN
776095000OtherINMAGELLAN
350868083OtherINTRICARE
88367428OtherINCIGNA
177120AOtherINMEDICARE
66108OtherINVALUE OPTIONS
LIC34001263AOtherINVALUE OPTIONS - GM CLIENTS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20111028000495 IN Practitioner - Clinical Psychologist 5193998623 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1974
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

101 S Washington St
Marion, IN 46952-3867
Phone (765) 622-9971

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
LIC20090165AINMDCounseling Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Grant-Blackford Mental Health, Inc. CurrentSince Apr 1, 2022 Accepting new patients
Grant-Blackford Mental Health, Inc. CurrentSince Apr 1, 2022 Accepting new patients

Locations

410 Pilgrim Blvd
Ste 100
Hartford City, IN 47348
Phone (765) 348-1303

3010 S Adams St
Marion, IN 46953
Phone (765) 662-3971

505 N Wabash Ave
Marion, IN 46952
Phone (765) 662-3971

101 S Washington St
Marion, IN 46952
Phone (765) 662-9971

101 S Washington St
Ste 200
Marion, IN 46952
Phone (765) 662-9971

116 E 32nd St
Marion, IN 46953
Phone (765) 662-2039

Organizations & group practices 2

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": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453939200000",
    "number": "1861505059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 S WASHINGTON ST",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469523867",
            "telephone_number": "765-662-9971",
            "fax_number": "765-651-6556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 S WASHINGTON ST",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469523867",
            "telephone_number": "765-662-9971",
            "fax_number": "765-651-6556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUPERSMITH",
        "first_name": "ARTHUR",
        "name_prefix": "Dr.",
        "credential": "PHD., HSPP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-15",
        "last_updated": "2016-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TH0100X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health Service",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "LIC20090165A",
            "primary": true
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "IN",
            "license": "LIC20090165A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100123560A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000317611",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MPLAN",
            "identifier": "4027",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN",
            "identifier": "776095000",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "350868083",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "88367428",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "177120A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "66108",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS - GM CLIENTS",
            "identifier": "LIC34001263A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marion, IN

Sources for this page

Verify at the official NPI Registry.