Individual provider Active NPI

Craig Steven McIntire-Mann, MS CCC-SLP

  • Speech-Language Pathologist
  • Walnut Creek, CA
National Provider Identifier
1053694281
Registry record updated Jul 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
15246 Issued in CA
Practice address
14 Oak Treat CT
Walnut Creek, CA 94597-6700
Phone
(925) 308-5717
NPI assigned
Sep 23, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 29, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 15246 CA Primary

Addresses

Primary practice location

14 Oak Treat CT
Walnut Creek, CA 94597-6700

Mailing address

14 Oak Treat CT
Walnut Creek, CA 94597-6700

Other practice location 1

1592 Sunnyvale Ave
#26
Walnut Creek, CA 94597-1934
Phone (925) 330-8429

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200812000650 CA Practitioner - Qualified Speech Language Pathologist 1658797337 Reassigns benefits to 1 organization
Practice locations: Walnut Creek, CA

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

Practice roles

OrganizationSpecialtyStatusNew patients
Converge Speech Therapy CurrentSince Jun 27, 2021 Accepting new patients
Orthopaedic and Neurological Rehabilitation, Speech Pathology, Inc CurrentSince Jul 1, 2020 Accepting new patients
Orthopaedic and Neurological Rehab Inc CurrentSince Jul 1, 2020 Accepting new patients

Locations

4751 Dallas Ranch Rd
Antioch, CA 94531
Phone (925) 350-0291

2950 Sierra Sunrise Ter
Chico, CA 95928
Phone (530) 941-1017

8500 Bluffstone Cv
Ste A201
Austin, TX 78759
Phone (512) 220-5252

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": "1316736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627516800000",
    "number": "1053694281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 OAK TREAT CT",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945976700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 OAK TREAT CT",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945976700",
            "telephone_number": "925-308-5717"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1592 Sunnyvale Ave",
            "address_2": "#26",
            "address_purpose": "LOCATION",
            "city": "Walnut Creek",
            "state": "CA",
            "postal_code": "945971934",
            "country_code": "US",
            "telephone_number": "925-330-8429",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCINTIRE-MANN",
        "first_name": "CRAIG",
        "middle_name": "STEVEN",
        "name_prefix": "Mr.",
        "credential": "MS CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-09-23",
        "last_updated": "2021-07-29",
        "certification_date": "2021-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "15246",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Walnut Creek, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 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.