Active NPI
Michael James Mahoney
- Hearing Instrument Specialist
- Saint Cloud, MN
National Provider Identifier
1144356973
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hearing Instrument Specialist
- License
- 2067
- Practice address
- 215 Park Ave S
Suite 101
Saint Cloud, MN 56301-3736 - Phone
- (320) 252-0452
- NPI assigned
- Feb 26, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Hearing Instrument Specialist | 237700000X | 2067 | MN | Primary |
Addresses
Primary practice location
215 Park Ave S
Suite 101
Saint Cloud, MN 56301-3736
Mailing address
215 Park Ave S
Suite 101
Saint Cloud, MN 56301-3736
Phone (320) 252-0452
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 45-80212 | Medicaid | MN | |
| 45-00200 | Medicaid | MN | |
| 110204 | Medicaid | MN | |
| 55030CL | Other | MN | BLUE CROSS& BLUE SHIELD |
| 82-81124 | Medicaid | MN |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 2067 | MN | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172448000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1144356973",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "215 PARK AVE S",
"address_2": "SUITE 101",
"city": "SAINT CLOUD",
"state": "MN",
"postal_code": "563013736",
"telephone_number": "320-252-0452"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "215 PARK AVE S",
"address_2": "SUITE 101",
"city": "SAINT CLOUD",
"state": "MN",
"postal_code": "563013736",
"telephone_number": "320-252-0452"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAHONEY",
"first_name": "MICHAEL",
"middle_name": "JAMES",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-26",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "237700000X",
"taxonomy_group": "",
"desc": "Hearing Instrument Specialist",
"state": "MN",
"license": "2067",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "45-80212",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "45-00200",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "110204",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS& BLUE SHIELD",
"identifier": "55030CL",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "82-81124",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Cloud, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.