NPIMap

Organization Active NPI

Henry Ford Macomb Hospital Corporation

  • Psychologist
  • Clinton Township, MI
National Provider Identifier
1992848972
Registry record updated Apr 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
HENRY FORD MACOMB HOSPITAL CORPORATION
Practice address
43411 Garfield Rd
Clinton Township, MI 48038-1152
Phone
(586) 226-7007
NPI assigned
Feb 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2021

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

Authorized official

Name
Terry A Goodbalian
Title
VP Cmo
Phone
(586) 263-2305

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103T00000X MI Primary
Clinical Child & Adolescent PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC2200X MI

Addresses

Primary practice location

43411 Garfield Rd
Clinton Township, MI 48038-1152

Mailing address

215 North Ave
Mount Clemens, MI 48043-1716
Phone (586) 226-7007

Other identifiers 1

IdentifierTypeStateIssuer
680E062890OtherMIBLUE CROSS GROUP NUMBER

Other names 1

  • Henry Ford Macomb Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040119000142 MI Part B Supplier - Clinic/Group Practice 7911808381 Receives reassigned benefits from 662 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Macomb, MI; Mount Clemens, MI; Richmond, MI; Romeo, MI; Shelby Township, MI; Clinton Township, MI; Sterling Heights, MI; Warren, MI…

Other NPIs on the same Medicare enrollment 12

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Member organizations 5

Organizations listed as members of this organization in the National Provider Directory.

Locations

43411 Garfield Rd
Clinton Twp, MI 48038
Phone (586) 226-7007

NPI Registry JSON

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619136000000",
    "number": "1992848972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 NORTH AVE",
            "city": "MOUNT CLEMENS",
            "state": "MI",
            "postal_code": "480431716",
            "telephone_number": "586-226-7007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43411 GARFIELD RD",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480381152",
            "telephone_number": "586-226-7007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HENRY FORD MACOMB HOSPITAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-15",
        "last_updated": "2021-04-23",
        "certification_date": "2021-04-23",
        "status": "A",
        "authorized_official_last_name": "GOODBALIAN",
        "authorized_official_first_name": "TERRY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "VP CMO",
        "authorized_official_telephone_number": "586-263-2305"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "MI",
            "license": null,
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "MI",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS GROUP NUMBER",
            "identifier": "680E062890",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Henry Ford Macomb Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Henry Ford Macomb Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clinton Township, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2021; 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.