Kevin Michael Pernicano, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

37643 Issued in TX

Practice address

8800 Village Drive
Ste 209
San Antonio, TX 78217

Phone

(210) 202-0100

Fax

(210) 579-9705

NPI assigned

May 9, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

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, 1981

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

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 and National Provider Directory roles.

• Pernicano Professional Psychology, PLLC

  • Clinical Psychologist
  • San Antonio, TX
  • NPI 1417518556
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1147132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584316800000",
    "number": "1083663835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2071 WIND CHIME WAY",
            "city": "NEW BRAUNFELS",
            "state": "TX",
            "postal_code": "78130",
            "telephone_number": "210-278-4584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8800 VILLAGE DRIVE",
            "address_2": "STE 209",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78217",
            "telephone_number": "210-202-0100",
            "fax_number": "210-579-9705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERNICANO",
        "first_name": "KEVIN",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-09",
        "last_updated": "2020-03-16",
        "certification_date": "2020-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "37643",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3749426",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS STATE PSYCHOLOGY LICENSE",
            "identifier": "37643",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kendall Perlwitz, CRNA
• Kevin Tyler Permann, PHARMD
• Senta Pernell, DENTAL HYGIENST
• Pernicano Professional Psychology, PLLC
• Pernicano Psychological Services, PLLC
• Abby Marie Perone, D.C.
• Miranda Elyse Perotti, RN IBCLC
• Peter Timothy Perretta, M.D.
• Catherine Renee Perri, LCSW
• Alice Perrier

• Clinical Psychologist in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Clinical Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 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.

Verify at the official NPI Registry.