Individual provider Active NPI

Ed Schmookler, PHD

  • Clinical Psychologist
  • Albany, CA
National Provider Identifier
1114131398
Registry record updated Sep 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY8597 Issued in CA
Practice address
1350 Solano Ave
Unit a
Albany, CA 94706-1853
Phone
(510) 524-3654
NPI assigned
May 9, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 7, 2018

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 PSY8597 CA Primary

Addresses

Primary practice location

1350 Solano Ave
Unit a
Albany, CA 94706-1853

Mailing address

1350 Solano Ave
Unit a
Albany, CA 94706-1853
Phone (510) 524-3654

Other identifiers 1

IdentifierTypeStateIssuer
PSY85970MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20101029000038 CA Practitioner - Clinical Psychologist 8820282379 Practice locations: Berkeley, CA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1332 Addison St
Berkeley, CA 94702-1717
Phone (510) 524-3654

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PSY8597CAMDClinical Psychologist
8597CAMDAcupuncturist

NPI Registry JSON

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

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536278400000",
    "number": "1114131398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 SOLANO AVE",
            "address_2": "UNIT A",
            "city": "ALBANY",
            "state": "CA",
            "postal_code": "947061853",
            "telephone_number": "510-524-3654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 SOLANO AVE",
            "address_2": "UNIT A",
            "city": "ALBANY",
            "state": "CA",
            "postal_code": "947061853",
            "telephone_number": "510-524-3654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHMOOKLER",
        "first_name": "ED",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-09",
        "last_updated": "2018-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY8597",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PSY85970",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, CA

Sources for this page

Verify at the official NPI Registry.