Individual provider Active NPI

Michael Scott Feeser

  • Speech-Language Assistant
  • San Jose, CA
National Provider Identifier
1639820665
Registry record updated Sep 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language AssistantTaxonomy code 2355S0801X
License
9038 Issued in CA
Practice address
911 Bern CT Ste 130
San Jose, CA 95112-1242
Phone
(408) 437-8864
NPI assigned
Jan 11, 2022
Last updated
Sep 30, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Assistant 2355S0801X 5391 FL
Speech-Language Assistant 2355S0801X 9038 CA Primary
Behavior Technician 106S00000X RBT-21-184776 NU

Addresses

Primary practice location

911 Bern CT Ste 130
San Jose, CA 95112-1242

Mailing address

4086 Tenita Dr
Winter Park, FL 32792-8944
Phone (407) 844-7298

Other identifiers 1

IdentifierTypeStateIssuer
112364100MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
9038CAMDOptometrist
5391FLMDSpeech-Language Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
County of Santa Clara PastSince Oct 6, 2024 Accepting new patients
Kredo Health LLC PastSince Jul 1, 2024 Accepting new patients
Integrated Intervention for Children With Autism PastSince Oct 6, 2024 Accepting new patients

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, 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": "1641859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727654400000",
    "number": "1639820665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4086 TENITA DR",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327928944",
            "telephone_number": "407-844-7298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 BERN CT STE 130",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951121242",
            "telephone_number": "408-437-8864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FEESER",
        "first_name": "MICHAEL",
        "middle_name": "SCOTT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-01-11",
        "last_updated": "2024-09-30",
        "certification_date": "2024-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2355S0801X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Speech-Language Assistant",
            "state": "FL",
            "license": "5391",
            "primary": false
        },
        {
            "code": "2355S0801X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Speech-Language Assistant",
            "state": "CA",
            "license": "9038",
            "primary": true
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "NU",
            "license": "RBT-21-184776",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112364100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.