Individual provider Active NPI

Breeona Namukowa, MD

  • Psychiatry Physician
  • Lansing, MI
National Provider Identifier
1972189884
Registry record updated Apr 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
4301514485 Issued in MI
Practice address
812 E Jolly Rd
Lansing, MI 48910-6825
Phone
(517) 237-7162
Fax
(517) 346-8291
NPI assigned
Mar 22, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 4301514485 MI Primary

Addresses

Primary practice location

812 E Jolly Rd
Lansing, MI 48910-6825

Mailing address

812 E Jolly Rd Ste 210
Lansing, MI 48910-6825
Phone (517) 237-7162

Other practice location 1

300 68th St SE
Grand Rapids, MI 49548-6927
Phone (616) 455-5000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address pinerestCMHS@directaddress.pinerest.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, MI2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20250326000324 MA Practitioner - Psychiatry 0042609406
I20260302001522 MI Practitioner - Psychiatry 0042609406 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Oakland Univ, William Beaumont School of Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Pine Rest Christian Mental Health ServicesGroup PAC ID 4981506508, 354 clinicians

Practice addresses (Care Compare)

300 68TH St SE
Grand Rapids, MI 49548-6927
Phone (616) 455-5000

812 E Jolly Rd
Lansing, MI 48910-6818
Phone (517) 346-8200

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301514485MIMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Boston Medical Center Corporation Current Accepting new patients
Community Mental Health Authority of Clinton Eaton Ingham Counties Psychiatry CurrentSince Jan 11, 2026 Accepting new patients

Locations

812 E Jolly Rd
Lansing, MI 48910
Phone (517) 237-7162

812 E Jolly Rd
Ste 210
Lansing, MI 48910
Phone (517) 237-7162

Interoperability endpoints

  • Direct secure messaging: bnamukowa140577@direct.bmc.masshiway.net

Organizations & group practices 3

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": "1616371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776211200000",
    "number": "1972189884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "812 E JOLLY RD STE 210",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489106825",
            "telephone_number": "517-237-7162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "812 E JOLLY RD",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489106825",
            "telephone_number": "517-237-7162",
            "fax_number": "517-346-8291"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 68th St SE",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495486927",
            "country_code": "US",
            "telephone_number": "616-455-5000",
            "fax_number": "616-455-5960",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NAMUKOWA",
        "first_name": "BREEONA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-22",
        "last_updated": "2026-04-15",
        "certification_date": "2026-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "4301514485",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pinerestCMHS@directaddress.pinerest.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "300 68th St SE",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495486927",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lansing, MI

Sources for this page

Verify at the official NPI Registry.