Individual provider Active NPI

Michael James Shaffran, LCSW

  • Clinical Social Worker
  • Morro Bay, CA
National Provider Identifier
1053461277
Registry record updated May 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCS 15788 Issued in CA
Practice address
159 Luzon St
Morro Bay, CA 93442-3019
Phone
(805) 225-1131
NPI assigned
Jan 11, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 2, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LCS 15788 CA Primary

Addresses

Primary practice location

159 Luzon St
Morro Bay, CA 93442-3019

Mailing address

159 Luzon St
Morro Bay, CA 93442-3019
Phone (805) 225-1131

Other identifiers 1

IdentifierTypeStateIssuer
LCS 15788OtherCALCSW

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101004000615 CA Practitioner - Clinical Social Worker 1355533837 Practice locations: Templeton, CA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

160 Hawley St
Templeton, CA 93465-5448
Phone (805) 296-3456

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCS 15788CAMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304294400000",
    "number": "1053461277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "159 LUZON ST",
            "city": "MORRO BAY",
            "state": "CA",
            "postal_code": "934423019",
            "telephone_number": "805-225-1131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "159 LUZON ST",
            "city": "MORRO BAY",
            "state": "CA",
            "postal_code": "934423019",
            "telephone_number": "805-225-1131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAFFRAN",
        "first_name": "MICHAEL",
        "middle_name": "JAMES",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-11",
        "last_updated": "2011-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS 15788",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LCSW",
            "identifier": "LCS 15788",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Morro Bay, CA

Sources for this page

Verify at the official NPI Registry.