Individual provider Active NPI

Charles F Spinazola Jr., PH.D.

  • Psychologist
  • Ann Arbor, MI
National Provider Identifier
1437161536
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
6301010943 Issued in MI
Practice address
2345 S Huron Pkwy
Ann Arbor, MI 48104-5124
Phone
(734) 761-1757
Fax
(734) 973-3057
NPI assigned
Aug 13, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 6301010943 MI Primary

Addresses

Primary practice location

2345 S Huron Pkwy
Ann Arbor, MI 48104-5124

Mailing address

2345 S Huron Pkwy
Ann Arbor, MI 48104-5124
Phone (734) 761-1757

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20201023002650 MI Practitioner - Clinical Psychologist 5799105177 Practice locations: Ann Arbor, MI

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1970
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2301 S Huron Pkwy
Suite 1C
Ann Arbor, MI 48104-5133
Phone (734) 761-1767

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
6301010943MIMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Integrative Neurology , PLLC PastSince Dec 14, 2015 Accepting new patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1437161536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2345 S HURON PKWY",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481045124",
            "telephone_number": "734-761-1757",
            "fax_number": "734-973-3057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2345 S HURON PKWY",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481045124",
            "telephone_number": "734-761-1757",
            "fax_number": "734-973-3057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPINAZOLA",
        "first_name": "CHARLES",
        "middle_name": "F",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301010943",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

Verify at the official NPI Registry.