Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

PINE RIVER PSYCHOLOGICAL SERVICES PLLC
NPI 1992660005
Psychologist - Clinical in Charlevoix, MI

Q: What is Pine River Psychological Services PLLC's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Active since December 20, 2025

221 BRIDGE ST, CHARLEVOIX, MI 49720(650) 387-3927 Get Directions Write a Review

NPPES record last updated: October 4, 2026. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Oct 4, 2026, Aug 1, 2026, Mar 17, 2026 and 1 more (4 updates tracked since 2025).

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About Pine River Psychological Services Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PINE RIVER PSYCHOLOGICAL SERVICES PLLC (NPI 1992660005) is a healthcare organization registered as a clinical in Charlevoix, Michigan and active in the NPI registry since December 2025. The organization lists Michael Di Martino, Managing Member, as its authorized official.

NPPES Registry Identity

NPI1992660005

Entity TypeOrganization

Primary Taxonomy103TC0700X

Legal Business NamePINE RIVER PSYCHOLOGICAL SERVICES PLLC

Location Address221 BRIDGE STCharlevoix, MI 49720-1400

Mailing Address221 Bridge StCharlevoix, MI 49720-1400 · (650) 387-3927

Phone(650) 387-3927

Organization SubpartNo

Authorized OfficialMichael Di MartinoManaging Member · (650) 387-3927

Enumeration DateDecember 20, 2025

Last NPPES UpdateOctober 4, 20264 updates tracked since enumeration

NPPES CertifiedOctober 4, 2026

✔ NPI 1992660005 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

221 BRIDGE ST, Charlevoix, MI 49720

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Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Pine River Psychological Services Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Pine River Psychological Services PLLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Michael Di Martino, PSY.D.

Clinical Psychologist

NPI 1316505969

221 BRIDGE ST
Charlevoix, MI 49720

(650) 387-3927

✔ PECOSSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Pine River Psychological Services PLLC's NPI number?

The NPI number for Pine River Psychological Services PLLC is 1992660005. It was assigned to this organization in the NPPES registry on December 20, 2025.

Where is Pine River Psychological Services PLLC located?

Pine River Psychological Services PLLC is located at 221 Bridge St, Charlevoix, MI 49720. The listed phone number is (650) 387-3927.

What is Pine River Psychological Services PLLC's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Pine River Psychological Services PLLC enrolled in Medicare?

Yes. Pine River Psychological Services PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Pine River Psychological Services PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Clinical Psychologist) reassigns their Medicare billing to Pine River Psychological Services PLLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Pine River Psychological Services PLLC was last updated on October 4, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 34 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.