Individual provider Active NPI

Mark Rogerson, PH.D.

  • Clinical Neuropsychologist
  • Niskayuna, NY
National Provider Identifier
1053546713
Registry record updated Aug 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
019256 Issued in NY
Practice address
2310 Nott St E
Niskayuna, NY 12309-4303
Phone
(518) 372-6080
NPI assigned
May 26, 2009
Last updated
Aug 29, 2011By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 29, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X 019256 NY Primary

Addresses

Primary practice location

2310 Nott St E
Niskayuna, NY 12309-4303

Mailing address

2310 Nott St E
Niskayuna, NY 12309-4303
Phone (518) 372-6080

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20110922000377 NY Practitioner - Clinical Psychologist 9133390172 Practice locations: Clifton Park, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
University of Texas Southwestern Medical School at Dallas, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

10 Maxwell Dr
Suite 205
Clifton Park, NY 12065-2933
Phone (518) 288-7156

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
019256NYMDClinical Neuropsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
R&M Neuropsychology, PLLC Clinical Neuropsychologist PastSince Mar 21, 2021 Accepting new patients
Martin Neuropsychology PLLC Clinical Neuropsychologist PastSince Nov 10, 2024 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1243296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314576000000",
    "number": "1053546713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2310 NOTT ST E",
            "city": "NISKAYUNA",
            "state": "NY",
            "postal_code": "123094303",
            "telephone_number": "518-372-6080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2310 NOTT ST E",
            "city": "NISKAYUNA",
            "state": "NY",
            "postal_code": "123094303",
            "telephone_number": "518-372-6080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROGERSON",
        "first_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-05-26",
        "last_updated": "2011-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "NY",
            "license": "019256",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Niskayuna, NY

Sources for this page

Verify at the official NPI Registry.