Individual provider Active NPI

Tami S Krichiver, PSYD, HSPP

  • Clinical Psychologist
  • Indianapolis, IN
National Provider Identifier
1013293687
Registry record updated Oct 27, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
20042554A Issued in IN
Practice address
2011 N Meridian St
Indianapolis, IN 46202-1305
Phone
(317) 924-7010
Fax
(317) 941-2208
NPI assigned
Oct 27, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 20042554A IN Primary

Addresses

Primary practice location

2011 N Meridian St
Indianapolis, IN 46202-1305

Mailing address

2011 N Meridian St
Indianapolis, IN 46202-1305
Phone (317) 924-7010

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120607000670 IN Practitioner - Clinical Psychologist 4284898040 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

6544 Ferguson St
Indianapolis, IN 46220-1178
Phone (317) 528-9110

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
20042554AINMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Qualife Psychology, LLC Clinical CurrentSince Feb 22, 2017 Accepting new patients

Locations

6544 Ferguson St
Indianapolis, IN 46220
Phone (317) 528-9110

Organizations & group practices 1

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": "1319673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319673600000",
    "number": "1013293687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2011 N MERIDIAN ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462021305",
            "telephone_number": "317-924-7010",
            "fax_number": "317-941-2208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2011 N MERIDIAN ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462021305",
            "telephone_number": "317-924-7010",
            "fax_number": "317-941-2208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRICHIVER",
        "first_name": "TAMI",
        "middle_name": "S",
        "credential": "PSYD, HSPP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-27",
        "last_updated": "2011-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20042554A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.