Bruce Allen Fowler, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301006137 Issued in MI

Practice address

2090 Celebration Dr NE
Suite 212
Grand Rapids, MI 49525-9200

Phone

(616) 450-4601

Fax

(616) 608-0108

NPI assigned

Sep 20, 2006

Last updated

Feb 8, 2017By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

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

Specialty

Clinical Psychologist

Education

Other, 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Dr Bruce a Fowler P C

  • Clinical Psychologist
  • Grand Rapids, MI
  • NPI 1992903363
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486512000000",
    "number": "1881792497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2090 CELEBRATION DR NE",
            "address_2": "SUITE 212",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259200",
            "telephone_number": "616-450-4601",
            "fax_number": "616-608-0108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2090 CELEBRATION DR NE",
            "address_2": "SUITE 212",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259200",
            "telephone_number": "616-450-4601",
            "fax_number": "616-608-0108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOWLER",
        "first_name": "BRUCE",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2017-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301006137",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD MI",
            "identifier": "680D115690",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Danielle E Fournier, LLMSW
• Leidy Fournier, PA-C
• Tristan Terrance Foust
• Natalie Rae Fowle
• Abbey Fowler, LLPC
• Bruce R Fowler III
• Cheryl Fowler, AGNP-C
• Elmer William Fowler Jr., DO PL
• Jaivian Fowler
• Kristina Fowler, OTR/L

• Clinical Psychologist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.