NPIMap

Individual provider Active NPI

Michael P Machose, BCBA, LPA

  • Psychologist
  • Charlotte, NC
National Provider Identifier
1992074934
Registry record updated Dec 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
4297 Issued in NC
Practice address
10926 S Tryon St Ste E
Charlotte, NC 28273-4154
Phone
(704) 931-8870
Fax
(866) 313-7602
NPI assigned
Dec 20, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 14, 2020

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X
Cognitive & Behavioral Psychologist 103TB0200X 4297 NC
School Psychologist 103TS0200X
Psychologist 103T00000X 4297 NC Primary

Addresses

Primary practice location

10926 S Tryon St Ste E
Charlotte, NC 28273-4154

Mailing address

10926 S Tryon St Ste E
Charlotte, NC 28273-4154
Phone (704) 931-8870

Other identifiers 2

IdentifierTypeStateIssuer
1487904041OtherNCNPPES
6107742MedicaidNC

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

LicenseStateTypeSpecialty
4297NCMDPediatric Occupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Connect Behavioral Health LLC Behavior Analyst Current Accepting new patients
Mosaic Group, LLC Behavior Analyst Past Accepting new patients
Delta Behavioral Group, PLLC Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1324339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607904000000",
    "number": "1992074934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10926 S TRYON ST STE E",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282734154",
            "telephone_number": "704-931-8870",
            "fax_number": "866-313-7602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10926 S TRYON ST STE E",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282734154",
            "telephone_number": "704-931-8870",
            "fax_number": "866-313-7602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACHOSE",
        "first_name": "MICHAEL",
        "middle_name": "P",
        "credential": "BCBA, LPA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-12-20",
        "last_updated": "2020-12-14",
        "certification_date": "2020-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "NC",
            "license": "4297",
            "primary": false
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NC",
            "license": "4297",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPPES",
            "identifier": "1487904041",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6107742",
            "state": "NC"
        }
    ],
    "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 Dec 14, 2020; 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.