Individual provider Active NPI

Robert Carlyle Irwin, PH.D.

  • Clinical Psychologist
  • Carlsbad, CA
National Provider Identifier
1124238696
Registry record updated Dec 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY 18284 Issued in CA
Practice address
2888 Loker Ave E Ste 110
Carlsbad, CA 92010-6683
Phone
(619) 884-3488
Fax
(760) 806-4340
NPI assigned
May 23, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 29, 2022

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 PSY 18284 CA Primary

Addresses

Primary practice location

2888 Loker Ave E Ste 110
Carlsbad, CA 92010-6683

Mailing address

2888 Loker Ave E Ste 110
Carlsbad, CA 92010-6683
Phone (619) 884-3488

Other identifiers 1

IdentifierTypeStateIssuer
8940635MedicaidCA

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
I20111012000841 CA Practitioner - Clinical Psychologist 4981876117 Practice locations: Carlsbad, CA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

2888 Loker Ave E
Suite 110
Carlsbad, CA 92010-6683
Phone (619) 884-3488

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PSY 18284CAMDClinical Psychologist

NPI Registry JSON

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672272000000",
    "number": "1124238696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2888 LOKER AVE E STE 110",
            "city": "CARLSBAD",
            "state": "CA",
            "postal_code": "920106683",
            "telephone_number": "619-884-3488",
            "fax_number": "760-806-4340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2888 LOKER AVE E STE 110",
            "city": "CARLSBAD",
            "state": "CA",
            "postal_code": "920106683",
            "telephone_number": "619-884-3488",
            "fax_number": "760-806-4340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IRWIN",
        "first_name": "ROBERT",
        "middle_name": "CARLYLE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-23",
        "last_updated": "2022-12-29",
        "certification_date": "2022-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY 18284",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8940635",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carlsbad, CA

Sources for this page

Verify at the official NPI Registry.