Active NPI
Jessica Awinita Stahl, PSY.D
- Psychologist
- Nevada City, CA
National Provider Identifier
1144487703
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY 24773
- Practice address
- 408 Broad St
Ste 10B
Nevada City, CA 95959-2455 - Phone
- (530) 210-6202
- NPI assigned
- May 21, 2008
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY 24773 | CA | Primary |
Addresses
Primary practice location
408 Broad St
Ste 10B
Nevada City, CA 95959-2455
Mailing address
PO Box 2008
Nevada City, CA 95959-1941
Phone (530) 210-6202
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120327000710 | CA | Practitioner - Clinical Psychologist | 7719147883 | Practice locations: Grass Valley, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
244 Cornwall Ave
Grass Valley, CA 95945-7117
Phone (530) 210-6202
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 24773 | CA | MD | Psychologist |
| 24773 | CA | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211328000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1629849600000",
"number": "1144487703",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2008",
"city": "NEVADA CITY",
"state": "CA",
"postal_code": "959591941",
"telephone_number": "530-210-6202"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "408 BROAD ST",
"address_2": "STE 10B",
"city": "NEVADA CITY",
"state": "CA",
"postal_code": "959592455",
"telephone_number": "530-210-6202"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STAHL",
"first_name": "JESSICA",
"middle_name": "AWINITA",
"credential": "PSY.D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-05-21",
"last_updated": "2021-08-25",
"certification_date": "2021-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY 24773",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Nevada City, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2021; 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.