Active NPI
Pooja Khariwal
- Clinical Psychologist
- Chattanooga, TN
National Provider Identifier
1063846822
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 3417
- Practice address
- 101 Jordan Dr
Chattanooga, TN 37421-6732 - Phone
- (423) 510-1999
- Fax
- (423) 510-1888
- NPI assigned
- Aug 29, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 3417 | TN | Primary |
| Psychologist | 103T00000X |
Addresses
Primary practice location
101 Jordan Dr
Chattanooga, TN 37421-6732
Mailing address
101 Jordan Dr
Chattanooga, TN 37421-6732
Phone (423) 510-1999
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
101 Jordan Dr
Chattanooga, TN 37421-6732
Phone 42351019998
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3417 | TN | MD | General Practice Dentistry |
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
- Chattanooga, TN
- NPI 1417568890
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1377734400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597104000000",
"number": "1063846822",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 JORDAN DR",
"city": "CHATTANOOGA",
"state": "TN",
"postal_code": "374216732",
"telephone_number": "423-510-1999",
"fax_number": "423-510-1888"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 JORDAN DR",
"city": "CHATTANOOGA",
"state": "TN",
"postal_code": "374216732",
"telephone_number": "423-510-1999",
"fax_number": "423-510-1888"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHARIWAL",
"first_name": "POOJA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-08-29",
"last_updated": "2020-08-11",
"certification_date": "2020-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TN",
"license": "3417",
"primary": true
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chattanooga, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2020; 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.