Individual provider Active NPI

Daniel A Tomczyk, PH.D.

  • Clinical Psychologist
  • Redmond, WA
National Provider Identifier
1114250495
Registry record updated Dec 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY60620631 Issued in WA
Practice address
8275 166TH Ave NE Ste 200
Redmond, WA 98052-6629
Phone
(425) 869-2644
Fax
(425) 867-0930
NPI assigned
Sep 17, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2023

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 PY60620631 WA Primary

Addresses

Primary practice location

8275 166TH Ave NE Ste 200
Redmond, WA 98052-6629

Mailing address

8275 166TH Ave NE Ste 200
Redmond, WA 98052-6629
Phone (425) 869-2644

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20160831002480 WA Practitioner - Clinical Psychologist 0244371797 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Emmaus Counseling Service PSGroup PAC ID 5193726701, 21 clinicians

Practice addresses (Care Compare)

8275 166TH Ave NE
Suite 200
Redmond, WA 98052-6629
Phone 42586926440

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PY60620631WAMDClinical Psychologist
34307TXMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Emmaus Counseling Service PS CurrentSince Aug 7, 2017 Accepting new patients
Deer Oaks Mental Health Associates PC Clinical Past Accepting new patients

Locations

2122 112th Ave NE
Ste B200
Bellevue, WA 98004

8275 166th Ave NE
Ste 102
Redmond, WA 98052
Phone 42586926440

8275 166th Ave NE
Ste 200
Redmond, WA 98052
Phone 4258692644 ext. 17

Organizations & group practices 2

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": "1253145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703030400000",
    "number": "1114250495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8275 166TH AVE NE STE 200",
            "city": "REDMOND",
            "state": "WA",
            "postal_code": "980526629",
            "telephone_number": "425-869-2644",
            "fax_number": "425-867-0930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8275 166TH AVE NE STE 200",
            "city": "REDMOND",
            "state": "WA",
            "postal_code": "980526629",
            "telephone_number": "425-869-2644",
            "fax_number": "425-867-0930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOMCZYK",
        "first_name": "DANIEL",
        "middle_name": "A",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-09-17",
        "last_updated": "2023-12-20",
        "certification_date": "2023-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "PY60620631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redmond, WA

Sources for this page

Verify at the official NPI Registry.