Active NPI
Emily Ruth Jernberg, PH. D.
- Clinical Psychologist
- Rochester Hills, MI
National Provider Identifier
1871590117
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301008691
- Practice address
- 1460 Walton Blvd
#202
Rochester Hills, MI 48309-1768 - Phone
- (248) 505-4161
- Fax
- (248) 601-9991
- NPI assigned
- Jul 1, 2005
- Last updated
- May 8, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6301008691 | MI | Primary |
Addresses
Primary practice location
1460 Walton Blvd
#202
Rochester Hills, MI 48309-1768
Mailing address
1460 Walton Blvd
#202
Rochester Hills, MI 48309-1768
Phone (248) 505-4161
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 1, 2022 through Oct 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301008691 | MI | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hague & Associates, Inc. | Past | Accepting new patients | |
| Thomas Payne & Associates Inc | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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- Clinical Social Worker
- Ann Arbor, MI
- NPI 1770818403
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120176000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1336435200000",
"number": "1871590117",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1460 WALTON BLVD",
"address_2": "#202",
"city": "ROCHESTER HILLS",
"state": "MI",
"postal_code": "483091768",
"telephone_number": "248-505-4161",
"fax_number": "248-601-9991"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1460 WALTON BLVD",
"address_2": "#202",
"city": "ROCHESTER HILLS",
"state": "MI",
"postal_code": "483091768",
"telephone_number": "248-505-4161",
"fax_number": "248-601-9991"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JERNBERG",
"first_name": "EMILY",
"middle_name": "RUTH",
"name_prefix": "Dr.",
"credential": "PH. D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-07-01",
"last_updated": "2012-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301008691",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rochester Hills, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.