Active NPI
Jerry G Balaban, PH.D.
- Clinical Psychologist
- Davis, CA
National Provider Identifier
1043435332
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY18667
- Practice address
- 3000 Woods Cir
Davis, CA 95616-2678 - Phone
- (539) 219-4528
- NPI assigned
- Apr 13, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY18667 | CA | Primary |
Addresses
Primary practice location
3000 Woods Cir
Davis, CA 95616-2678
Mailing address
3000 Woods Cir
Davis, CA 95616-2678
Phone (539) 219-4528
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PSY18667 | Other | CA | CALIF LIC |
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18667 | CA | MD | Professional Counselor |
| PSY18667 | CA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Darrell Broaddus Psychological Services PC | Clinical | Past | Accepting new patients |
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.
-
- Clinical Psychologist
- Orangevale, CA
- NPI 1215339650
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176422400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1043435332",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3000 WOODS CIR",
"city": "DAVIS",
"state": "CA",
"postal_code": "956162678",
"telephone_number": "539-219-4528"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3000 WOODS CIR",
"city": "DAVIS",
"state": "CA",
"postal_code": "956162678",
"telephone_number": "539-219-4528"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALABAN",
"first_name": "JERRY",
"middle_name": "G",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY18667",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CALIF LIC",
"identifier": "PSY18667",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Davis, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.