Individual provider Active NPI

Michael Joseph Perry, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Utica, NY
National Provider Identifier
1205146941
Registry record updated Jun 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
401302 Issued in NY
Practice address
1400 Noyes St
Utica, NY 13502-3854
Phone
(315) 738-4075
Fax
(907) 260-3697
NPI assigned
Oct 15, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 1478 AK
Psychiatric/Mental Health Nurse Practitioner 363LP0808X F401302-1 NY
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 401302 NY Primary

Addresses

Primary practice location

1400 Noyes St
Utica, NY 13502-3854

Mailing address

995 Beaver Creek Rd
Waterville, NY 13480-2403
Phone (315) 737-1542

Other identifiers 1

IdentifierTypeStateIssuer
1619189MedicaidAK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231018001565 NY Order and Referring Only - Nurse Practitioner 9931367018

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1478AKMDDentist
401302NYMDPsychiatric/Mental Health Nurse Practitioner
F401302-1NYMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Peninsula Community Health Services of Alaska, Inc. Past Accepting new patients
Nys Office of Mental Health Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/AEIFAA

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": "1287100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718236800000",
    "number": "1205146941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "995 BEAVER CREEK RD",
            "city": "WATERVILLE",
            "state": "NY",
            "postal_code": "134802403",
            "telephone_number": "315-737-1542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 NOYES ST",
            "city": "UTICA",
            "state": "NY",
            "postal_code": "135023854",
            "telephone_number": "315-738-4075",
            "fax_number": "907-260-3697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERRY",
        "first_name": "MICHAEL",
        "middle_name": "JOSEPH",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-10-15",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AK",
            "license": "1478",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "F401302-1",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "401302",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1619189",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Utica, NY

Sources for this page

Verify at the official NPI Registry.