Active NPI
Richard Price Gibb, DMH
- Clinical Psychologist
- Fort Bragg, CA
National Provider Identifier
1154538171
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY11640
- Practice address
- 1102 S Main St
Fort Bragg, CA 95437 - Phone
- (707) 964-6191
- Fax
- (707) 964-6191
- NPI assigned
- May 17, 2007
- 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 | PSY11640 | CA | Primary |
Addresses
Primary practice location
1102 S Main St
Fort Bragg, CA 95437
Mailing address
PO Box 1208
Fort Bragg, CA 95437-1208
Phone (707) 964-6191
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6138313 | Other | CA | USBH |
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 |
|---|---|---|---|---|
| I20040818000783 | CA | Practitioner - Clinical Psychologist | 8729051610 | Practice locations: Fort Bragg, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- University of California, San Francisco School of Medicine, 1986
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
17700 Ocean Dr
Fort Bragg, CA 95437-8225
Phone (707) 964-6191
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY11640 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1531699200000",
"number": "1154538171",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1208",
"city": "FORT BRAGG",
"state": "CA",
"postal_code": "954371208",
"telephone_number": "707-964-6191",
"fax_number": "707-964-6191"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1102 S MAIN ST",
"city": "FORT BRAGG",
"state": "CA",
"postal_code": "95437",
"telephone_number": "707-964-6191",
"fax_number": "707-964-6191"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBB",
"first_name": "RICHARD",
"middle_name": "PRICE",
"name_prefix": "Dr.",
"credential": "DMH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-17",
"last_updated": "2018-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY11640",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "USBH",
"identifier": "6138313",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Bragg, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2018; 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.