Rachele Elizabeth Sage, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Practice address

139 Beal Pkwy SE Unit 107
Fort Walton Beach, FL 32548-5343

Phone

(850) 803-2562

NPI assigned

Jan 2, 2018

Reactivated

Jun 25, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Rachele Maddox Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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.

• Cardinal ABA Services, LLC

  • Behavior Analyst
  • Fort Walton Beach, FL
  • NPI 1730758277
  NPD Authorized official

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

{
    "created_epoch": "1514851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629763200000",
    "number": "1750898516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 KNOLLWOOD WAY",
            "city": "FT. WALTON BEACH",
            "state": "FL",
            "postal_code": "32548",
            "telephone_number": "850-803-2562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 BEAL PKWY SE UNIT 107",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325485343",
            "telephone_number": "850-803-2562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAGE",
        "first_name": "RACHELE",
        "middle_name": "ELIZABETH",
        "credential": "BCBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-01-02",
        "last_updated": "2021-08-24",
        "certification_date": "2021-08-24",
        "deactivation_date": "2021-05-20",
        "reactivation_date": "2021-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RACHELE",
            "last_name": "MADDOX",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Behavior Analyst in Fort Walton Beach, FL
• Providers in Fort Walton Beach, FL by specialty
• Behavior Analyst in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 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.