Active NPI
Lothar Engelbert Mader, PHD
- Psychologist
- Roseville, CA
National Provider Identifier
1063400422
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY8474
- Practice address
- 2130 Professional Dr
Suite 240
Roseville, CA 95661-3738 - Phone
- (916) 782-2100
- Fax
- (916) 624-0701
- NPI assigned
- Oct 10, 2005
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY8474 | CA | Primary |
Addresses
Primary practice location
2130 Professional Dr
Suite 240
Roseville, CA 95661-3738
Mailing address
2130 Professional Dr
Suite 240
Roseville, CA 95661-3738
Phone (916) 782-2100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7366414 | Medicaid | CA |
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 |
|---|---|---|---|
| 8474 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128902400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193961600000",
"number": "1063400422",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2130 PROFESSIONAL DR",
"address_2": "SUITE 240",
"city": "ROSEVILLE",
"state": "CA",
"postal_code": "956613738",
"telephone_number": "916-782-2100",
"fax_number": "916-624-0701"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2130 PROFESSIONAL DR",
"address_2": "SUITE 240",
"city": "ROSEVILLE",
"state": "CA",
"postal_code": "956613738",
"telephone_number": "916-782-2100",
"fax_number": "916-624-0701"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MADER",
"first_name": "LOTHAR",
"middle_name": "ENGELBERT",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-10-10",
"last_updated": "2007-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY8474",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7366414",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Roseville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 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.