Active NPI
Michael Anthony Bomar II, MSW, LCSW, LISW-CP
- Clinical Social Worker
- Charlotte, NC
National Provider Identifier
1750608337
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- C008005
- Practice address
- 1909 J N Pease PL Ste 103
Charlotte, NC 28262-4560 - Phone
- (803) 984-7051
- NPI assigned
- Apr 22, 2010
- 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 Social Worker | 1041C0700X | C008005 | NC | Primary |
| Clinical Social Worker | 1041C0700X | 10267 | SC |
Addresses
Primary practice location
1909 J N Pease PL Ste 103
Charlotte, NC 28262-4560
Mailing address
1909 J N Pease PL Ste 103
Charlotte, NC 28262-4560
Phone (803) 984-7051
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
| License | State | Type | Specialty |
|---|---|---|---|
| C008005 | NC | MD | Clinical Social Worker |
| 10267 | SC | MD | Developmental - Behavioral Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1271894400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1428624000000",
"number": "1750608337",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1909 J N PEASE PL STE 103",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282624560",
"telephone_number": "803-984-7051"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1909 J N PEASE PL STE 103",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282624560",
"telephone_number": "803-984-7051"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOMAR",
"first_name": "MICHAEL",
"middle_name": "ANTHONY",
"name_suffix": "II",
"credential": "MSW, LCSW, LISW-CP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-04-22",
"last_updated": "2015-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": "C008005",
"primary": true
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "SC",
"license": "10267",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 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.