Individual provider Active NPI

Jared Lee Warren, PSY.D.

  • Clinical Psychologist
  • Bradenton, FL
National Provider Identifier
1093204117
Registry record updated Jul 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY11939 Issued in FL
Practice address
4835 27TH St W Ste 125
Bradenton, FL 34207-1759
Phone
(941) 753-0064
Fax
(866) 636-1355
NPI assigned
May 3, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2023

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 PY11939 FL Primary

Addresses

Primary practice location

4835 27TH St W Ste 125
Bradenton, FL 34207-1759

Mailing address

4835 27TH St W Ste 125
Bradenton, FL 34207-1759
Phone (941) 753-0064

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20230804001149 FL Practitioner - Clinical Psychologist 0143681262 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Debra K Carter PH D and Associates PAGroup PAC ID 0547234379, 9 clinicians

Practice addresses (Care Compare)

4835 27TH St W
Suite 125
Bradenton, FL 34207-1759
Phone (941) 753-0064

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

LicenseStateTypeSpecialty
PY11939FLMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Debra K Carter PH D & Associates PA Clinical CurrentSince Aug 7, 2023 Accepting new patients

Locations

4835 27th St W
Ste 125
Bradenton, FL 34207
Phone (941) 753-0064

Networks

  • Freedom Health HMO Network

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.

NPI Registry JSON

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

{
    "created_epoch": "1525305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690156800000",
    "number": "1093204117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4835 27TH ST W STE 125",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342071759",
            "telephone_number": "941-753-0064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4835 27TH ST W STE 125",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342071759",
            "telephone_number": "941-753-0064",
            "fax_number": "866-636-1355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARREN",
        "first_name": "JARED",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-03",
        "last_updated": "2023-07-24",
        "certification_date": "2023-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY11939",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bradenton, FL

Sources for this page

Verify at the official NPI Registry.