Organization Active NPI

Michael Pica P.C.

  • Psychologist
  • St Charles, IL
National Provider Identifier
1730449315
Registry record updated Jul 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
MICHAEL PICA P.C.
Practice address
4N701 School Rd Ste a
St Charles, IL 60175-6508
Phone
(630) 549-6497
Fax
(630) 549-0942
NPI assigned
May 17, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2019

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

Authorized official

Name
Dr. Michael Pica, PSYDNPI 1356455505
Title
President/Clinical Psychologist
Phone
(630) 373-7349

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X Primary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X

Addresses

Primary practice location

4N701 School Rd Ste a
St Charles, IL 60175-6508

Mailing address

4N701 School Rd Ste a
Saint Charles, IL 60175-6508
Phone (630) 549-6497

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190702001827 IL Part B Supplier - Clinic/Group Practice 1254665847 Receives reassigned benefits from 3 practitioners
Practice locations: Geneva, IL; Saint Charles, IL

National Provider Directory

National Provider Directory

Locations

127 S 1st St
Ste 105
Geneva, IL 60134
Phone (630) 549-6497

40W222 Lafox Rd
Ste H1
St Charles, IL 60175
Phone (630) 444-0082

4N701 School Rd
Ste A
St Charles, IL 60175
Phone (630) 549-6497

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1337212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562025600000",
    "number": "1730449315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4N701 SCHOOL RD STE A",
            "city": "SAINT CHARLES",
            "state": "IL",
            "postal_code": "601756508",
            "telephone_number": "630-549-6497",
            "fax_number": "630-549-0942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4N701 SCHOOL RD STE A",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601756508",
            "telephone_number": "630-549-6497",
            "fax_number": "630-549-0942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL PICA P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-17",
        "last_updated": "2019-07-02",
        "status": "A",
        "authorized_official_last_name": "PICA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT/CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "630-373-7349",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Charles, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.