Samuel A Montano, PHD
Individual provider Active NPI Clinical Psychologist · Clovis, CA
NPI 1164048609 · NPPES record last updated Nov 20, 2024
Key facts
- NPI
- 1164048609
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- PSY28917 (CA)
- Practice address
- 255 W Bullard Ave Ste 101
Clovis, CA 93612-0861 - Phone
- (559) 443-8687
- NPI assigned
- Jun 20, 2020
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Central Valley Indian Health Inc
Practice addresses (Care Compare)
255 W Bullard Ave
Clovis, CA 93612-0861
29323 Auberry Rd
Prather, CA 93651-9757
Phone (559) 855-5390
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240927000593 | CA | Practitioner - Clinical Psychologist | 4183155427 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY28917 | CA | MD | Clinical Psychologist |
| 28917 | CA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Central Valley Indian Health Inc | Current |
Accepting new patients | |
| Central Valley Indian Health, Inc. | Current |
Accepting new patients | |
| Central Valley Indian Health, Inc | Past | Accepting new patients |
Locations
255 W Bullard Ave
Ste 109
Clovis, CA 93612
Phone (559) 297-7563
2740 Herndon Ave
Clovis, CA 93611
Phone (559) 299-2608
29369 Auberry Rd
Ste 102
Prather, CA 93651
Phone (559) 855-5390
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY28917 | CA | Yes |
Addresses
Primary practice location
255 W Bullard Ave Ste 101
Clovis, CA 93612-0861
Mailing address
255 W Bullard Ave Ste 101
Clovis, CA 93612-0861
Phone (559) 299-2435
Other providers in Clovis, CA
- Gisela Erica Mondragon
- Shirley Mondragon
- Ayanna Montalvo
- Sandra Marie Montalvo
- Anthony W Montana
- Stacey Melissa Montes
- Suzanne Montgomery
- Lizbeth Montiel-Gonzalez
- Ana Gabriela Monzon
- Ashley Moon
All providers in Clovis, CA · Clinical Psychologist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 20, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.