NPIMap

Individual provider Active NPI

Susan Skolek, PSYD

  • Psychologist
  • Guerneville, CA
National Provider Identifier
1114923745
Registry record updated Apr 4, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PSY20220 Issued in CA
Practice address
16319 Third Street
Guerneville, CA 95446
Phone
(707) 869-2849
Fax
(707) 869-1477
NPI assigned
Jun 28, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PSY20220 CA Primary

Addresses

Primary practice location

16319 Third Street
Guerneville, CA 95446

Mailing address

PO Box 1449
Guerneville, CA 95446-1449
Phone (707) 869-2849

Other identifiers 3

IdentifierTypeStateIssuer
FHC03887FMedicaidCA
ZZZ73222ZOtherMEDICARE ID
FHC70957FMedicaidCA

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
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PSY20220CAMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
West County Health Centers, Inc. PastSince Jan 1, 1990 Accepting new patients
West County Health Centers, Inc. PastSince Jan 1, 1990 Accepting new patients
West County Health Centers, Inc PastSince Jan 1, 1990 Accepting new patients
West County Health Centers, Inc PastSince Jan 1, 1990 Accepting new patients
West County Health Centers, Inc. PastSince Jan 1, 1990 Accepting new patients
West County Health Centers, Inc. PastSince Jan 1, 1990 Accepting new patients
West County Health Centers, Inc. PastSince Jan 1, 1990 Accepting new patients
West County Health Centers, Inc. PastSince Jan 1, 1990 Accepting new patients
West County Health Centers, Inc. PastSince Jan 1, 1990 Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IIBEAA

Organizations & group practices 9

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": "1119916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207267200000",
    "number": "1114923745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1449",
            "city": "GUERNEVILLE",
            "state": "CA",
            "postal_code": "954461449",
            "telephone_number": "707-869-2849",
            "fax_number": "707-869-1477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16319 THIRD STREET",
            "city": "GUERNEVILLE",
            "state": "CA",
            "postal_code": "95446",
            "telephone_number": "707-869-2849",
            "fax_number": "707-869-1477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SKOLEK",
        "first_name": "SUSAN",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-28",
        "last_updated": "2008-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY20220",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC03887F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "ZZZ73222Z",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC70957F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Guerneville, CA

Sources for this page

Verify at the official NPI Registry.