Active NPI
Michael B Connolly, CADC II
- Community Health Worker
- Martinez, CA
National Provider Identifier
1144737362
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- Practice address
- 4645 Pacheco Blvd
Martinez, CA 94553-3625 - Phone
- (925) 646-9270
- Fax
- (925) 646-9276
- NPI assigned
- Jan 9, 2018
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 179638 | CA | |
| Substance Use Disorder Rehabilitation Clinic/Center | 261QR0405X | 179638 | CA | |
| Community Health Worker | 172V00000X | Primary |
Addresses
Primary practice location
4645 Pacheco Blvd
Martinez, CA 94553-3625
Mailing address
259 Saint Germain LN
Pleasant Hill, CA 94523-1117
Phone (510) 253-3645
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AII31410819 | Other | CA | CCAPP |
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 |
|---|---|---|---|
| 179638 | CA | MD | Substance Use Disorder Rehabilitation Clinic/Center |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1515456000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717459200000",
"number": "1144737362",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "259 SAINT GERMAIN LN",
"city": "PLEASANT HILL",
"state": "CA",
"postal_code": "945231117",
"telephone_number": "510-253-3645"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4645 PACHECO BLVD",
"city": "MARTINEZ",
"state": "CA",
"postal_code": "945533625",
"telephone_number": "925-646-9270",
"fax_number": "925-646-9276"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONNOLLY",
"first_name": "MICHAEL",
"middle_name": "B",
"credential": "CADC II",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-01-09",
"last_updated": "2024-06-04",
"certification_date": "2024-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "179638",
"primary": false
},
{
"code": "261QR0405X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
"state": "CA",
"license": "179638",
"primary": false
},
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CCAPP",
"identifier": "AII31410819",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Martinez, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.