Active NPI
Jay Gattis, PSY.D.
- Clinical Psychologist
- Costa Mesa, CA
National Provider Identifier
1104072610
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY19382
- Practice address
- 2900 Bristol St
Ste A108
Costa Mesa, CA 92626-5981 - Phone
- (714) 432-0042
- Fax
- (714) 432-0049
- NPI assigned
- Aug 15, 2008
- Sex
- Male
- 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 | PSY19382 | CA | Primary |
Addresses
Primary practice location
2900 Bristol St
Ste A108
Costa Mesa, CA 92626-5981
Mailing address
2900 Bristol St
Ste A108
Costa Mesa, CA 92626-5981
Phone (714) 432-0042
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 1, 2016 through Oct 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY19382 | CA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Psychological Enrichment Center | Clinical | Past | Accepting new patients |
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.
-
- Clinical Psychologist
- Costa Mesa, CA
- NPI 1942409255
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1218758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1218758400000",
"number": "1104072610",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2900 BRISTOL ST",
"address_2": "STE A108",
"city": "COSTA MESA",
"state": "CA",
"postal_code": "926265981",
"telephone_number": "714-432-0042",
"fax_number": "714-432-0049"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2900 BRISTOL ST",
"address_2": "STE A108",
"city": "COSTA MESA",
"state": "CA",
"postal_code": "926265981",
"telephone_number": "714-432-0042",
"fax_number": "714-432-0049"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GATTIS",
"first_name": "JAY",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-08-15",
"last_updated": "2008-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY19382",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Costa Mesa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2008; 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.