Individual provider Active NPI

Michael L Tomasello Jr., D.C.

  • Chiropractor
  • Marietta, GA
National Provider Identifier
1700807930
Registry record updated Apr 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CHIR005275 Issued in GA
Practice address
1415 Barclay Cir SE
Marietta, GA 30060-2943
Phone
(770) 426-2786
Fax
(770) 792-6113
NPI assigned
Jul 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CHIR005275 GA Primary

Addresses

Primary practice location

1415 Barclay Cir SE
Marietta, GA 30060-2943

Mailing address

1415 Barclay Cir SE
Marietta, GA 30060-2943
Phone (770) 426-2786

Other practice location 1

2000 Powers Ferry Rd SE
Suite 1-10
Marietta, GA 30067-9476
Phone (770) 859-9579

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
CHIR005275GAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Hoopinsocker Incorporated Chiropractor Past 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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617840000000",
    "number": "1700807930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 BARCLAY CIR SE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300602943",
            "telephone_number": "770-426-2786",
            "fax_number": "770-792-6113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 BARCLAY CIR SE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300602943",
            "telephone_number": "770-426-2786",
            "fax_number": "770-792-6113"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2000 Powers Ferry Rd SE",
            "address_2": "SUITE 1-10",
            "address_purpose": "LOCATION",
            "city": "Marietta",
            "state": "GA",
            "postal_code": "300679476",
            "country_code": "US",
            "telephone_number": "770-859-9579",
            "fax_number": "770-859-9299",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TOMASELLO",
        "first_name": "MICHAEL",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-22",
        "last_updated": "2021-04-08",
        "certification_date": "2021-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "CHIR005275",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2021; 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.