Individual provider Active NPI

Diane M Kanous

  • Psychologist
  • Kalamazoo, MI
National Provider Identifier
1871638445
Registry record updated Nov 6, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
6301011265 Issued in MI
Practice address
3030 S 9TH St
Suite 2GB
Kalamazoo, MI 49009-7956
Phone
(269) 544-7720
Fax
(269) 544-7721
NPI assigned
Feb 21, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 6301011265 MI Primary

Addresses

Primary practice location

3030 S 9TH St
Suite 2GB
Kalamazoo, MI 49009-7956

Mailing address

3030 S 9TH St
Suite 2GB
Kalamazoo, MI 49009-7956
Phone (269) 544-7720

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241127000284 MI Practitioner - Psychologist Billing Independently 5193885200 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6301011265MIMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Diane M Kanous CurrentSince Sep 28, 2008 Accepting new patients
Dorman and Associates PLC Psychologist PastSince Oct 22, 2024 Accepting new patients

Locations

3030 S 9th St
Ste 2GB
Kalamazoo, MI 49009
Phone (269) 544-7720

6963 W Kl Ave
#B
Kalamazoo, MI 49009
Phone (269) 544-7720

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": "1172016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1225929600000",
    "number": "1871638445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3030 S 9TH ST",
            "address_2": "SUITE 2GB",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490097956",
            "telephone_number": "269-544-7720",
            "fax_number": "269-544-7721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 S 9TH ST",
            "address_2": "SUITE 2GB",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490097956",
            "telephone_number": "269-544-7720",
            "fax_number": "269-544-7721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANOUS",
        "first_name": "DIANE",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-21",
        "last_updated": "2008-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301011265",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2008; 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.