Individual provider Active NPI

Michael William Faust Sr., PH.D.

  • Clinical Psychologist
  • Cleveland, OH
National Provider Identifier
1356387468
Registry record updated Dec 22, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
4749 Issued in OH
Practice address
1730 W 25TH St
Cleveland, OH 44113-3108
Phone
(216) 363-2363
Fax
(216) 696-7488
NPI assigned
Jun 20, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 22, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 4749 OH Primary

Addresses

Primary practice location

1730 W 25TH St
Cleveland, OH 44113-3108

Mailing address

1730 W 25TH St
Cleveland, OH 44113-3108
Phone (216) 363-2363

Other identifiers 1

IdentifierTypeStateIssuer
0967584MedicaidOH

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20120508000247 OH Practitioner - Clinical Psychologist 1850553967 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1730 W 25TH St
Cleveland, OH 44113-3108
Phone (216) 363-2363

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
4749OHMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Faust Psychological Services, Inc. Clinical CurrentSince Jan 1, 2001 Accepting new patients

Locations

1730 W 25th St
Ste 444A
Cleveland, OH 44113
Phone (216) 363-2363

1730 W 25th St
Cleveland, OH 44113
Phone (216) 696-4300

Organizations & group practices 1

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": "1150761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1292976000000",
    "number": "1356387468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1730 W 25TH ST",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441133108",
            "telephone_number": "216-363-2363",
            "fax_number": "216-696-7488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1730 W 25TH ST",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441133108",
            "telephone_number": "216-363-2363",
            "fax_number": "216-696-7488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAUST",
        "first_name": "MICHAEL",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "name_suffix": "Sr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-20",
        "last_updated": "2010-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OH",
            "license": "4749",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0967584",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

Verify at the official NPI Registry.