Sofie Ling Champassak, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY30201 Issued in CA

Practice address

3411 3Rd Ave
San Diego, CA 92103-4906

Phone

(619) 722-5797

Fax

(619) 354-2480

NPI assigned

Jul 31, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

Clinical Psychologist

Education

Other, 2016

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 and National Provider Directory roles.

• Sofie PHD Psychology Co

  • Clinical Psychologist
  • San Diego, CA
  • NPI 1518587526
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1532995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567468800000",
    "number": "1114405305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26331",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921960331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3411 3RD AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921034906",
            "telephone_number": "619-722-5797",
            "fax_number": "619-354-2480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAMPASSAK",
        "first_name": "SOFIE",
        "middle_name": "LING",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-31",
        "last_updated": "2019-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY30201",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PSYCHIATRY",
            "identifier": "PSY30201",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katelynn Marie Bridget Champagne, M.D.
• Lynne Michelle Champagne, MD
• Nicole Nmi Champagne, LCSW
• Shrilekha M Champaneri, M.D.
• Manish Champaneria, MD
• Champion Rehabilitation
• Michelle Champlin, PTA
• Sarkawt Chamsaydi
• Pui Yen Karina Chan Liang, PHARMD
• Alex Chan, DO

• Clinical Psychologist in San Diego, CA
• Providers in San Diego, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2019; 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.