NPIMap

Individual provider Active NPI

Martin Carolan

  • Behavior Analyst
  • Rutland, MA
National Provider Identifier
1083084552
Registry record updated Sep 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
11415702 Issued in MA
Practice address
60 Miles Rd
Rutland, MA 01543-1423
Phone
(508) 886-4746
Fax
(508) 886-2274
NPI assigned
Sep 28, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 28, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X 11415702 MA Primary

Addresses

Primary practice location

60 Miles Rd
Rutland, MA 01543-1423

Mailing address

60 Miles Rd
Rutland, MA 01543-1423
Phone (508) 886-4746

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
11415702MAMDBehavioral Analyst

Practice roles

OrganizationSpecialtyStatusNew patients
Devereux Foundation Past Accepting new patients
Devereux 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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1443398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1443398400000",
    "number": "1083084552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 MILES RD",
            "city": "RUTLAND",
            "state": "MA",
            "postal_code": "015431423",
            "telephone_number": "508-886-4746",
            "fax_number": "508-886-2274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 MILES RD",
            "city": "RUTLAND",
            "state": "MA",
            "postal_code": "015431423",
            "telephone_number": "508-886-4746",
            "fax_number": "508-886-2274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAROLAN",
        "first_name": "MARTIN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-09-28",
        "last_updated": "2015-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "MA",
            "license": "11415702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rutland, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.