Michael A Forman, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

2928 Issued in OH

Practice address

3545 Olentangy RVR Rd
Suite 214
Columbus, OH 43214-3907

Phone

(614) 263-5908

Fax

(614) 263-5941

NPI assigned

Aug 1, 2005

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 1

Medicare fee-for-service enrollment

Enrolled in OH

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 Psychologist

Education

Other, 1979

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Michael a Forman PHD Inc

  • Psychologist
  • Columbus, OH
  • NPI 1508923137
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1122854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349740800000",
    "number": "1194726133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3545 OLENTANGY RVR RD",
            "address_2": "SUITE 214",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432143907",
            "telephone_number": "614-263-5908",
            "fax_number": "614-263-5941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3545 OLENTANGY RVR RD",
            "address_2": "SUITE 214",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432143907",
            "telephone_number": "614-263-5908",
            "fax_number": "614-263-5941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORMAN",
        "first_name": "MICHAEL",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-01",
        "last_updated": "2012-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OH",
            "license": "2928",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0426686",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dixon Alfred Fayiah Forleh
• Form and Function Healthcare LLC
• Charles Forman
• Heather R Forman, DPT
• Kelly Ann Forman, LSW
• Nancy Walker Forman, PHD
• Patricia R Forman, M.D.
• Nicole M Fornalski, PSYD
• Ella Mae Forney
• Nikkeya Forney, LPN

• Psychologist in Columbus, OH
• Providers in Columbus, OH by specialty
• Psychologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2012; 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.