Active NPI
Thomas Elwin Mates, PHD
- Clinical Psychologist
- Wilmington, NC
National Provider Identifier
1720116304
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1092
- Practice address
- 7032 Wrightsville Ave
Suite 103B
Wilmington, NC 28403-3743 - Phone
- (910) 256-6163
- Fax
- (910) 256-6748
- NPI assigned
- Mar 2, 2007
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1092 | NC | Primary |
| Psychologist | 103T00000X | 1092 | NC |
Addresses
Primary practice location
7032 Wrightsville Ave
Suite 103B
Wilmington, NC 28403-3743
Mailing address
7032 Wrightsville Ave
Suite 103B
Wilmington, NC 28403-3743
Phone (910) 256-6163
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6000190 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective May 24, 2018 through May 24, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1092 | NC | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1380499200000",
"number": "1720116304",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7032 WRIGHTSVILLE AVE",
"address_2": "SUITE 103B",
"city": "WILMINGTON",
"state": "NC",
"postal_code": "284033743",
"telephone_number": "910-256-6163",
"fax_number": "910-256-6748"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7032 WRIGHTSVILLE AVE",
"address_2": "SUITE 103B",
"city": "WILMINGTON",
"state": "NC",
"postal_code": "284033743",
"telephone_number": "910-256-6163",
"fax_number": "910-256-6748"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATES",
"first_name": "THOMAS",
"middle_name": "ELWIN",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-02",
"last_updated": "2013-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NC",
"license": "1092",
"primary": true
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NC",
"license": "1092",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6000190",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wilmington, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.