Active NPI
Michael Bruce Pines, PHD
- Psychologist
- Glastonbury, CT
National Provider Identifier
1891887691
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(1) exclusion effective Nov 20, 2024.
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- CT671
- Practice address
- 41C New London Turnpike
Glastonbury, CT 06033-4206 - Phone
- (860) 659-0579
- Fax
- (860) 659-0570
- NPI assigned
- Sep 29, 2006
- Sex
- Male
- Sole proprietor
- No
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 | CT671 | CT | Primary |
Addresses
Primary practice location
41C New London Turnpike
Glastonbury, CT 06033-4206
Mailing address
41C New London Turnpike
Glastonbury, CT 06033-4206
Phone (860) 659-0579
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
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CT671 | CT | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1891887691",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "41C NEW LONDON TURNPIKE",
"city": "GLASTONBURY",
"state": "CT",
"postal_code": "060334206",
"telephone_number": "860-659-0579",
"fax_number": "860-659-0570"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "41C NEW LONDON TURNPIKE",
"city": "GLASTONBURY",
"state": "CT",
"postal_code": "060334206",
"telephone_number": "860-659-0579",
"fax_number": "860-659-0570"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PINES",
"first_name": "MICHAEL",
"middle_name": "BRUCE",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CT",
"license": "CT671",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glastonbury, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.