Individual provider Active NPI

Grace P Davidson, PHD

  • Clinical Psychologist
  • Plano, TX
National Provider Identifier
1093790586
Registry record updated Apr 29, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
2-3603 Issued in TX
Practice address
1700 Alma
Suite 315
Plano, TX 75075-6962
Phone
(972) 596-6351
Fax
(972) 509-9062
NPI assigned
Dec 7, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 29, 2013

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 2-3603 TX Primary

Addresses

Primary practice location

1700 Alma
Suite 315
Plano, TX 75075-6962

Mailing address

1700 Alma Dr
Suite 315
Plano, TX 75075-6937
Phone (972) 596-6351

Other identifiers 3

IdentifierTypeStateIssuer
83212POtherTXPARKLAND MEDICARE NUMBER
00G80YOtherTXBLUECROSS BLUESHIELD
4343549OtherTXAETNA

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20090529000329 TX Practitioner - Clinical Psychologist 3476611922 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Deer Oaks Geriatric Services P CGroup PAC ID 9234034075, 45 clinicians

Practice addresses (Care Compare)

7272 Wurzbach Rd
San Antonio, TX 78240-4803
Phone (210) 615-3483

Merit-based Incentive Payment System (MIPS)

Final score
91.17 of 100Reported as group
Quality
83.48
Improvement activities
40
Cost
67.52

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
2-3603TXMDClinical Psychologist
23603TXMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Deer Oaks Geriatric Services P C Clinical CurrentSince Apr 28, 2021 Accepting new patients
Deer Oaks Mental Health Associates PC Clinical Past Accepting new patients
Vickery Health Center Past Accepting new patients
John W. Beaty, PH.D.,P.C. Past Accepting new patients
Dallas County Hospital District Past Accepting new patients

Locations

3759 Valley View Rd
Austin, TX 78704
Phone (512) 443-3436

7272 Wurzbach Rd
Ste 706
San Antonio, TX 78240
Phone (210) 615-3401

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1133913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1367193600000",
    "number": "1093790586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 ALMA DR",
            "address_2": "SUITE 315",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750756937",
            "telephone_number": "972-596-6351",
            "fax_number": "972-509-9062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 ALMA",
            "address_2": "SUITE 315",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750756962",
            "telephone_number": "972-596-6351",
            "fax_number": "972-509-9062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIDSON",
        "first_name": "GRACE",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-12-07",
        "last_updated": "2013-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "2-3603",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARKLAND MEDICARE NUMBER",
            "identifier": "83212P",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD",
            "identifier": "00G80Y",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4343549",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plano, TX

Sources for this page

Verify at the official NPI Registry.