Heather Pedersen, PH.D.

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

PSY31209 Issued in CA

Practice address

264 Clovis Ave # 104
Clovis, CA 93612-1115

Phone

(559) 777-9061

NPI assigned

Apr 1, 2014

Last updated

Apr 21, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 6

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Clinical Psychologist

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Pacific Stone Psychology Corporation

  • Clinical Neuropsychologist
  • Clovis, CA
  • NPI 1770167371
  Medicare reassignment NPD Authorized official
• Community Foundation Medical Group

  dba Sante' Foundation Medical Group

  • Internal Medicine Physician
  • Fresno, CA
  • NPI 1811258510
  Medicare reassignment NPD
• Community Foundation Medical Group

  dba Sante' Foundation Medical Group

  • Orthopaedic Surgery Physician
  • Fresno, CA
  • NPI 1134668353
  NPD
• Community Foundation Medical Group

  dba Sante' Foundation Medical Group

  • Orthopaedic Surgery Physician
  • Fresno, CA
  • NPI 1376056721
  NPD
• Family Support Services Inc.

  dba Sagent Behavioral Health

  • Mental Health Counselor
  • New Brighton, MN
  • NPI 1467549220
  NPD
• Central California Faculty Medical Group, Inc.

  • Internal Medicine Physician
  • Clovis, CA
  • NPI 1992742852
  NPD (past)

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

{
    "created_epoch": "1396310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618963200000",
    "number": "1083032635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "264 CLOVIS AVENUE #104",
            "address_2": "264 CLOVIS AVENUE #104",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "93612",
            "telephone_number": "559-777-9061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "264 CLOVIS AVE # 104",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936121115",
            "telephone_number": "559-777-9061"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6733 N Willow Ave Ste 107",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937105953",
            "country_code": "US",
            "telephone_number": "559-435-4700",
            "fax_number": "559-298-7951",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2335 E Kashian Ln Ste 301",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937012234",
            "country_code": "US",
            "telephone_number": "559-264-9100",
            "fax_number": "559-264-9199",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PEDERSEN",
        "first_name": "HEATHER",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-01",
        "last_updated": "2021-04-21",
        "certification_date": "2021-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CA",
            "license": "PSY31209",
            "primary": true
        },
        {
            "code": "103TA0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Adult Development & Aging",
            "state": "CA",
            "license": "PSY31209",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "CA",
            "license": "PSY31209",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY31209",
            "primary": false
        },
        {
            "code": "103TM1800X",
            "taxonomy_group": "",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": "CA",
            "license": "PSY31209",
            "primary": false
        },
        {
            "code": "103TR0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Rehabilitation",
            "state": "CA",
            "license": "PSY31209",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Linda C. Pauls, MD
• Rebecca Kay Payne, LVN
• Peachwood Aesthetic Skincare Center Inc.
• Peachwood Medical Group Clovis Inc
• Briana Estee Pearson
• Stacy Pederson
• Alejandra Pedraza, RN
• Pegasus Health System, Inc.
• Karen Pelayo Palmer, NP
• Dora Maria Pelletier, MD

• Clinical Neuropsychologist in Clovis, CA
• Providers in Clovis, CA by specialty
• Clinical Neuropsychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2021; 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.

Verify at the official NPI Registry.