Active NPI
Jennifer Jane Ballerini, PSY.D.
- Clinical Psychologist
- Fair Oaks, CA
National Provider Identifier
1093966053
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY22155
- Practice address
- 8080 Madison Ave
Ste 200 D
Fair Oaks, CA 95628-3759 - Phone
- (916) 276-7709
- Fax
- (916) 534-7753
- NPI assigned
- Oct 8, 2008
- Last updated
- May 27, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY22155 | CA | Primary |
Addresses
Primary practice location
8080 Madison Ave
Ste 200 D
Fair Oaks, CA 95628-3759
Mailing address
8080 Madison Ave
Ste 200 D
Fair Oaks, CA 95628-3759
Phone (916) 276-7709
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Oct 23, 2019 through Oct 23, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22155 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1223424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1243382400000",
"number": "1093966053",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8080 MADISON AVE",
"address_2": "STE 200 D",
"city": "FAIR OAKS",
"state": "CA",
"postal_code": "956283759",
"telephone_number": "916-276-7709",
"fax_number": "916-534-7753"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8080 MADISON AVE",
"address_2": "STE 200 D",
"city": "FAIR OAKS",
"state": "CA",
"postal_code": "956283759",
"telephone_number": "916-276-7709",
"fax_number": "916-534-7753"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALLERINI",
"first_name": "JENNIFER",
"middle_name": "JANE",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-10-08",
"last_updated": "2009-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY22155",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fair Oaks, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2009; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.