Carmen Pulido, PH.D.

Primary specialty

Prescribing (Medical) PsychologistTaxonomy code 103TP0016X

License

327121 Issued in LA

Practice address

723 E Highway 30
Gonzales, LA 70737-4715

Phone

(225) 743-2698

Fax

(225) 743-2028

NPI assigned

May 11, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in LA, TX2 enrollments

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 2

Specialty

Clinical Psychologist

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mind Health PLLC

  • Clinical Psychologist
  • Sugar Land, TX
  • NPI 1528684552
  Medicare reassignment NPD Authorized official
• Southern Psychological Specialists LLC

  • Clinical Psychologist
  • New Orleans, LA
  • NPI 1144983628
  Medicare reassignment NPD
• Metrolab, Inc.

  • Clinical Medical Laboratory
  • New Orleans, LA
  • NPI 1861572430
  NPD (past)
• Our Lady of the Lake Assumption Community Hospital

  dba Assumption Community Hospital

  • Rural Health Clinic/Center
  • Napoleonville, LA
  • NPI 1710975545
  NPD (past)
• Our Lady of the Lake Physician Group LLC

  dba OLOL Physician Surgical Specialty

  • Hematology & Oncology Physician
  • Baton Rouge, LA
  • NPI 1184671455
  NPD (past)

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

{
    "created_epoch": "1305072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664496000000",
    "number": "1104118058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15902 HEATHERDALE DR",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770595920",
            "telephone_number": "858-405-1769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "723 E HIGHWAY 30",
            "city": "GONZALES",
            "state": "LA",
            "postal_code": "707374715",
            "telephone_number": "225-743-2698",
            "fax_number": "225-743-2028"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15902 Heatherdale Dr",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770595920",
            "country_code": "US",
            "telephone_number": "858-298-3471",
            "fax_number": "858-999-0597",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "143 Highway 402 Ste 4",
            "address_purpose": "LOCATION",
            "city": "Napoleonville",
            "state": "LA",
            "postal_code": "703902217",
            "country_code": "US",
            "telephone_number": "985-369-1083",
            "fax_number": "985-369-1085",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "135 Highway 402",
            "address_purpose": "LOCATION",
            "city": "Napoleonville",
            "state": "LA",
            "postal_code": "703902217",
            "country_code": "US",
            "telephone_number": "985-369-4250",
            "fax_number": "985-369-6163",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PULIDO",
        "first_name": "CARMEN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-05-11",
        "last_updated": "2022-09-30",
        "certification_date": "2022-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "TX",
            "license": "37321",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY 24207",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "LA",
            "license": "327121",
            "primary": false
        },
        {
            "code": "103TP0016X",
            "taxonomy_group": "",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": "LA",
            "license": "327121",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "37321",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Profound Transport LLC (Profound Diagnostics)
• Promise Hospital of Ascension Inc
• Promise Hospital of Baton Rouge, Inc (Promise Hospital of Gonzales)
• Protouch Health & Wellness
• Amy Shepherd Pruden, APRN
• Pulmonary & Digestive Clinic Inc
• Pure at Heart Inc
• Gregory P Quartano, LCSW
• Amanda Trenell Quiett
• Ryan James Quinn, ATC

• Prescribing (Medical) Psychologist in Gonzales, LA
• Providers in Gonzales, LA by specialty
• Prescribing (Medical) Psychologist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2022; 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.