Jennifer Marie Gross, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY61194123 Issued in WA

Practice address

15418 Main St
Mill Creek, WA 98012-9030

Phone

(425) 339-5453

Fax

(425) 252-4441

NPI assigned

Nov 2, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Optum Care Washington PLLCGroup PAC ID 6406752153, 684 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Optum Care Washington PLLC

  • Multi-Specialty Clinic/Center
  • Everett, WA
  • NPI 1831186766
  Medicare reassignment Care Compare group NPD
• The Polyclinic PLLC

  • Audiologist
  • Seattle, WA
  • NPI 1174594634
  Medicare reassignment NPD
• Jennifer Gross, PSYD, Inc

  • Clinic/Center
  • Mill Creek, WA
  • NPI 1386398816
  NPD Authorized official
• Optum Care Washington PLLC

  • Durable Medical Equipment & Medical Supplies
  • Marysville, WA
  • NPI 1194428425
  NPD
• The Polyclinic PLLC

  • Durable Medical Equipment & Medical Supplies
  • Tacoma, WA
  • NPI 1831411487
  NPD

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688083200000",
    "number": "1023197951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5127",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982065127",
            "telephone_number": "425-304-8431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15418 MAIN ST",
            "city": "MILL CREEK",
            "state": "WA",
            "postal_code": "980129030",
            "telephone_number": "425-339-5453",
            "fax_number": "425-252-4441"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "805 164th St SE Ste 101",
            "address_purpose": "LOCATION",
            "city": "Mill Creek",
            "state": "WA",
            "postal_code": "980126316",
            "country_code": "US",
            "telephone_number": "206-300-6644",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GROSS",
        "first_name": "JENNIFER",
        "middle_name": "MARIE",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-02",
        "last_updated": "2023-06-30",
        "certification_date": "2023-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "00005653",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "PY61194123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Barbara J. Graham, PH.D.
• Leah Adela Grant
• Joy Miki Green, OTR/L
• Darren S Greenhalgh, DDS
• Enid Carla Griffin, PSY.D.
• Victor H. Grutchfield, RPH
• Hemanth Kumar Gurrala
• Michael Gwanjaye, LW61575358
• Akiko Hall, MD
• Joseph N. Hall, DPM,FACFAS

• Clinical Psychologist in Mill Creek, WA
• Providers in Mill Creek, WA by specialty
• Clinical Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.