Active NPI
Michael David Penticuff, PH.D.
- Psychologist
- Austin, TX
National Provider Identifier
1720043722
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 2-5038
- Practice address
- 1707 Enfield Rd
Austin, TX 78703-3308 - Phone
- (512) 454-9300
- Fax
- (512) 454-9370
- NPI assigned
- Apr 20, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 2-5038 | TX | Primary |
Addresses
Primary practice location
1707 Enfield Rd
Austin, TX 78703-3308
Mailing address
1707 Enfield Rd
Austin, TX 78703-3308
Phone (512) 454-9300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0362865-01 | Medicaid | TX |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2-5038 | TX | MD | Psychologist |
| 25038 | TX | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1438646400000",
"number": "1720043722",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1707 ENFIELD RD",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787033308",
"telephone_number": "512-454-9300",
"fax_number": "512-454-9370"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1707 ENFIELD RD",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787033308",
"telephone_number": "512-454-9300",
"fax_number": "512-454-9370"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENTICUFF",
"first_name": "MICHAEL",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-20",
"last_updated": "2015-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "TX",
"license": "2-5038",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0362865-01",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.