Michael Cole Pendergast, MSW, LICSW, ACSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

ISW01338 Issued in RI

Practice address

4705A Old Post Rd
Charlestown, RI 02813-1819

Phone

(401) 364-7705

NPI assigned

Dec 19, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in RI

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

Specialty

Clinical Social Worker

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Michael Pendergast

  • Clinical Social Worker
  • North Kingstown, RI
  • NPI 1043660202
  NPD (past) Authorized official
• Gateway Healthcare Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Pawtucket, RI
  • NPI 1821078932
  NPD (past)
• Karen Gieseke, PHD & Associates Inc.

  • Psychologist
  • Bristol, RI
  • NPI 1134203573
  NPD (past)
• South Shore Center Inc

  • Group Psychotherapy Psychologist
  • Charlestown, RI
  • NPI 1255327391

  Clinical

  NPD (past)

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1217808000000",
    "number": "1124181243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 899",
            "address_2": "SOUTH SHORE MENTAL HEALTH CENTER",
            "city": "CHARLESTOWN",
            "state": "RI",
            "postal_code": "02813",
            "telephone_number": "401-364-7705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4705A OLD POST RD",
            "city": "CHARLESTOWN",
            "state": "RI",
            "postal_code": "028131819",
            "telephone_number": "401-364-7705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENDERGAST",
        "first_name": "MICHAEL",
        "middle_name": "COLE",
        "credential": "MSW, LICSW, ACSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-19",
        "last_updated": "2008-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "RI",
            "license": "ISW01338",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MP34524",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "27303-7",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHIP",
            "identifier": "408142",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jane Palmer, RN
• Michelle Palmer, CNM
• Dawn Panciera, RN
• Pasture Lane Group Home
• Karen Anna Pelchat, LCSW
• Michaela M Perry, LICSW
• Perspectives Corporation
• Perspectives Corporation
• Paige Johanna Peterson, DMD
• Seth Piccolo Sr., LCDP

• Clinical Social Worker in Charlestown, RI
• Providers in Charlestown, RI by specialty
• Clinical Social Worker in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2008; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.