Active NPI
Randall Shipley
- School Psychologist
- Bellbrook, OH
National Provider Identifier
1154727246
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- SP228
- Practice address
- 3601 Big Tree Rd
Bellbrook, OH 45305-1973 - Phone
- (937) 848-4922
- NPI assigned
- Nov 17, 2014
- Last updated
- Nov 17, 2014
- 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 |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | SP228 | OH | Primary |
Addresses
Primary practice location
3601 Big Tree Rd
Bellbrook, OH 45305-1973
Mailing address
3601 Big Tree Rd
Bellbrook, OH 45305-1973
Phone (937) 848-4922
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SP228 | OH | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1416182400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1416182400000",
"number": "1154727246",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3601 BIG TREE RD",
"city": "BELLBROOK",
"state": "OH",
"postal_code": "453051973",
"telephone_number": "937-848-4922"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3601 BIG TREE RD",
"city": "BELLBROOK",
"state": "OH",
"postal_code": "453051973",
"telephone_number": "937-848-4922"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIPLEY",
"first_name": "RANDALL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-11-17",
"last_updated": "2014-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "OH",
"license": "SP228",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bellbrook, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.