Kimberly Shaffer Tate, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

4664 Issued in OH

Practice address

35 Iron Gate Park Dr.
Centerville, OH 45459-0000

Phone

(937) 435-8864

Fax

(937) 435-8264

NPI assigned

Oct 5, 2006

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

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, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southwestern Ohio Behavioral Health,LLC

  • Clinical Psychologist
  • Centerville, OH
  • NPI 1376631713
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1154418903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 41158",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454410158",
            "telephone_number": "937-435-8864",
            "fax_number": "937-435-8264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 IRON GATE PARK DR.",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454590000",
            "telephone_number": "937-435-8864",
            "fax_number": "937-435-8264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TATE",
        "first_name": "KIMBERLY",
        "middle_name": "SHAFFER",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-05",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OH",
            "license": "4664",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Synergy Family Therapy Specialists Inc
• Synergy Homecare of South Dayton
• Daria Tabor
• Jamal M Taha, M.D.
• Taj a Rashid MD Inc
• Regina Joy Tatman, OH APRN 026633
• Carrie Leigh Taylor, LSW
• Deanna Lynne Taylor, PA
• Grace Ann Taylor
• Terencevjonesllc (Medcare Solutions)

• Clinical Psychologist in Centerville, OH
• Providers in Centerville, OH by specialty
• Clinical Psychologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.