Active NPI
O. M. Custer, ED.D.
- Clinical Psychologist
- Ione, CA
National Provider Identifier
1134598295
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY 22981
- Practice address
- 14 West Main St
Suite 5
Ione, CA 95640-1415 - Phone
- (209) 642-0724
- NPI assigned
- Sep 18, 2015
- Last updated
- Sep 18, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY 22981 | CA | Primary |
Addresses
Primary practice location
14 West Main St
Suite 5
Ione, CA 95640-1415
Mailing address
PO Box 1415
Ione, CA 95640-1415
Phone (209) 642-0724
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 22981 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1442534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1442534400000",
"number": "1134598295",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1415",
"city": "IONE",
"state": "CA",
"postal_code": "956401415",
"telephone_number": "209-642-0724"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14 WEST MAIN ST",
"address_2": "SUITE 5",
"city": "IONE",
"state": "CA",
"postal_code": "956401415",
"telephone_number": "209-642-0724"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CUSTER",
"first_name": "O. M.",
"name_prefix": "Dr.",
"credential": "ED.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-09-18",
"last_updated": "2015-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY 22981",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.