Individual provider Active NPI

Michael S Hatesohl, MD

  • Psychiatry Physician
  • Fairborn, OH
National Provider Identifier
1427510510
Registry record updated Jan 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
35.144731 Issued in OH
Practice address
2555 University Dr
Fairborn, OH 45324-6255
Phone
(937) 775-7792
NPI assigned
Apr 5, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 35.144731 OH Primary

Addresses

Primary practice location

2555 University Dr
Fairborn, OH 45324-6255

Mailing address

2900 Presidential Dr Ste 100
Beavercreek, OH 45324-6502
Phone (216) 468-5000

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: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230620001180 OH Practitioner - Psychiatry 8325381189 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Psychological and Behavioral Consultants LLCGroup PAC ID 0446243760, 595 clinicians

Practice addresses (Care Compare)

25101 Chagrin Blvd
Suite 100
Beachwood, OH 44122-5694
Phone (216) 831-6611

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35.144731OHMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Psychological & Behavioral Consultants, LLC Psychiatry CurrentSince Mar 3, 2024 Accepting new patients
Mahajan Therapeutics, LLC CurrentSince May 10, 2023 Accepting new patients

Locations

25101 Chagrin Blvd
Ste 100
Beachwood, OH 44122
Phone (216) 245-4468

2900 Presidential Dr
Ste 100
Beavercreek, OH 45324
Phone (513) 741-3100

2900 Presidential Dr
Beavercreek, OH 45324
Phone (844) 719-1674

6300 N Main St
Dayton, OH 45415
Phone (937) 275-1500

25111 Country Club Blvd
Ste 290
North Olmsted, OH 44070
Phone (440) 614-2520

Interoperability endpoints

  • Direct secure messaging: lifestancehealth.michaelhatesohl@140094.advancedmd-direct.com
  • Direct secure messaging: lifestancehealth.michaelhatesohl@140098.advancedmd-direct.com

Organizations & group practices 3

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": "1554422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704931200000",
    "number": "1427510510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 PRESIDENTIAL DR STE 100",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "453246502",
            "telephone_number": "216-468-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2555 UNIVERSITY DR",
            "city": "FAIRBORN",
            "state": "OH",
            "postal_code": "453246255",
            "telephone_number": "937-775-7792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HATESOHL",
        "first_name": "MICHAEL",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-05",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OH",
            "license": "35.144731",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairborn, OH

Sources for this page

Verify at the official NPI Registry.