Active NPI
Michael Christopher Changaris, PSY.D. LIC#:PSY24712
- Psychologist
- Berkeley, CA
National Provider Identifier
1013107135
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY24712
- Practice address
- 771 San Luis Rd
Berkeley, CA 94707-2001 - Phone
- (510) 214-2559
- NPI assigned
- Jul 25, 2007
- Last updated
- Feb 15, 2012
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY24712 | CA | Primary |
Addresses
Primary practice location
771 San Luis Rd
Berkeley, CA 94707-2001
Mailing address
771 San Luis Rd
Berkeley, CA 94707-2001
Phone (510) 214-2559
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY24712 | CA | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Counseling Services for Seniors, a Licensed Clinical Social Worker Co | 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.
-
dba West County Adult Mental Health Services
- Adult Mental Health Clinic/Center
- San Pablo, CA
- NPI 1376620336
-
- Clinical Social Worker
- Oakland, CA
- NPI 1194030999
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185321600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1329264000000",
"number": "1013107135",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "771 SAN LUIS RD",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947072001",
"telephone_number": "510-214-2559"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "771 SAN LUIS RD",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947072001",
"telephone_number": "510-214-2559"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHANGARIS",
"first_name": "MICHAEL",
"middle_name": "CHRISTOPHER",
"name_prefix": "Dr.",
"credential": "PSY.D. LIC#:PSY24712",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-07-25",
"last_updated": "2012-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY24712",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berkeley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2012; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.