Active NPI
Michael G.S. Gottfried, PH.D.
- Psychologist
- Town and Country, MO
National Provider Identifier
1790994309
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 2002021877
- Practice address
- 14377 Woodlake Dr Ste 315
Town and Country, MO 63017-5735 - Phone
- (314) 304-3707
- NPI assigned
- May 21, 2007
- Last updated
- Jan 9, 2019
- 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 | 2002021877 | MO | Primary |
Addresses
Primary practice location
14377 Woodlake Dr Ste 315
Town and Country, MO 63017-5735
Mailing address
14377 Woodlake Dr Ste 315
Town and Country, MO 63017-5735
Phone (314) 304-3707
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 Feb 1, 2016 through Feb 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2002021877 | MO | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179705600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1546992000000",
"number": "1790994309",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14377 WOODLAKE DR STE 315",
"city": "TOWN AND COUNTRY",
"state": "MO",
"postal_code": "630175735",
"telephone_number": "314-304-3707"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14377 WOODLAKE DR STE 315",
"city": "TOWN AND COUNTRY",
"state": "MO",
"postal_code": "630175735",
"telephone_number": "314-304-3707"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOTTFRIED",
"first_name": "MICHAEL",
"middle_name": "G.S.",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-21",
"last_updated": "2019-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MO",
"license": "2002021877",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Town and Country, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2019; 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.