Individual provider Active NPI

Michael T Maricle, P.A.

  • Physician Assistant
  • Emeryville, CA
National Provider Identifier
1992147946
Registry record updated Jan 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA23212 Issued in CA
Practice address
2100 Powell St
Ste 900
Emeryville, CA 94608-1826
Phone
(510) 350-2600
Fax
(510) 879-9084
NPI assigned
Jul 18, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA23212 CA Primary
Physician Assistant 363A00000X

Addresses

Primary practice location

2100 Powell St
Ste 900
Emeryville, CA 94608-1826

Mailing address

2100 Powell St
Ste 900
Emeryville, CA 94608-1844
Phone (510) 350-2600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131113000159 CA Practitioner - Physician Assistant 2062648454 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cottage Clinical Network LLCGroup PAC ID 1850712530, 57 clinicians

Practice addresses (Care Compare)

777 E Foothill Blvd
San Luis Obispo, CA 93405-1617
Phone (805) 762-4348

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
23212CAMDOccupational Therapist
PA23212CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America - California CurrentSince Oct 1, 2013 Accepting new patients
Cep America - California CurrentSince Oct 1, 2022 Accepting new patients

Locations

3901 Lone Tree Way
Antioch, CA 94509
Phone (925) 779-7200

2755 Herndon Ave
Clovis, CA 93611
Phone (559) 323-4000

2100 Powell St
Ste 900
Emeryville, CA 94608
Phone (510) 350-2777

2100 Powell St
Ste 400
Emeryville, CA 94608
Phone (510) 350-2638

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

15031 Rinaldi St
San Fernando, CA 91345
Phone (818) 365-8051

1601 Ygnacio Valley Rd
Walnut Creek, CA 94598
Phone (925) 295-1545

Organizations & group practices 5

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": "1374105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1514937600000",
    "number": "1992147946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 POWELL ST",
            "address_2": "STE 900",
            "city": "EMERYVILLE",
            "state": "CA",
            "postal_code": "946081844",
            "telephone_number": "510-350-2600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 POWELL ST",
            "address_2": "STE 900",
            "city": "EMERYVILLE",
            "state": "CA",
            "postal_code": "946081826",
            "telephone_number": "510-350-2600",
            "fax_number": "510-879-9084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARICLE",
        "first_name": "MICHAEL",
        "middle_name": "T",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-18",
        "last_updated": "2018-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA23212",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Emeryville, CA

Sources for this page

Verify at the official NPI Registry.