Gary Ryan Page, MA

Primary specialty

PsychologistTaxonomy code 103T00000X

Practice address

1515 Mockingbird LN Ste 580
Charlotte, NC 28209-1171

Phone

(704) 910-8381

Fax

(704) 981-8282

NPI assigned

Sep 6, 2022

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Oct 31, 2023 through Oct 31, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

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.

• Base, PLLC

  • Psychologist
  • Charlotte, NC
  • NPI 1265936108
  NPD (past)

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

{
    "created_epoch": "1662422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662422400000",
    "number": "1609597806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 MOCKINGBIRD LN STE 580",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282091171",
            "telephone_number": "704-910-8381",
            "fax_number": "704-981-8282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 MOCKINGBIRD LN STE 580",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282091171",
            "telephone_number": "704-910-8381",
            "fax_number": "704-981-8282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAGE",
        "first_name": "GARY",
        "middle_name": "RYAN",
        "credential": "MA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-09-06",
        "last_updated": "2022-09-06",
        "certification_date": "2022-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Pagano, LCSW
• Richard Ralph Pagano, MD
• Alexander Townsend Page
• Camille Page
• Emily Virginia Page, FNP-C
• Holly Page
• Jennifer Lynn Page, PA
• Kandace Burnette Page, FNP-C
• Madison Page
• Margaret Bullen Page

• Psychologist in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.