Individual provider Active NPI

Alexandra Mattern-Roggelin, PSYD

  • Clinical Psychologist
  • York, PA
National Provider Identifier
1073016515
Registry record updated May 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
05990 Issued in MD
Practice address
3550 Concord Rd
York, PA 17402-8626
Phone
(717) 851-6340
Fax
(717) 851-6349
NPI assigned
Mar 12, 2018
Last updated
May 9, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 05990 MD Primary

Addresses

Primary practice location

3550 Concord Rd
York, PA 17402-8626

Mailing address

3421 Concord Rd
York, PA 17402-9001
Phone (717) 851-1405

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20180606000036 PA Practitioner - Clinical Psychologist 2961767314 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
05990MDMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Wellspan Medical Group CurrentSince Jun 1, 2018 Accepting new patients
Pennsylvania Department of Public Welfare CurrentSince May 18, 2020 Accepting new patients
Pennsylvania Department of Human Services CurrentSince May 18, 2020 Accepting new patients
Wellspan Medical Group CurrentSince Jun 1, 2018 Accepting new patients
Wellspan Medical Group Current Accepting new patients

Locations

160 Main St
Wernersville, PA 19565
Phone (610) 670-4100

25 Monument Rd
Ste 270
York, PA 17403
Phone (717) 741-8250

3421 Concord Rd
York, PA 17402
Phone (717) 851-2441

3550 Concord Rd
York, PA 17402
Phone (717) 851-1546

Organizations & group practices 5

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": "1520812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525824000000",
    "number": "1073016515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3421 CONCORD RD",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174029001",
            "telephone_number": "717-851-1405",
            "fax_number": "717-851-6969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3550 CONCORD RD",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174028626",
            "telephone_number": "717-851-6340",
            "fax_number": "717-851-6349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTERN-ROGGELIN",
        "first_name": "ALEXANDRA",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-12",
        "last_updated": "2018-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MD",
            "license": "05990",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in York, PA

Sources for this page

Verify at the official NPI Registry.