Richard Ettelson, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

D5418953 Issued in CA

Practice address

10630 Town Center Dr Ste 120
Rancho Cucamonga, CA 91730-6889

Phone

(909) 989-0901

Fax

(909) 941-1087

NPI assigned

Jun 22, 2006

Sex

Male

Sole proprietor

No

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 CA

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, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Memory Check Psychological Services, a Professional CorporationGroup PAC ID 7416856422, 78 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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 and National Provider Directory roles.

• Memory Check Psychological Services, a Professional Corporation

  • Clinical Psychologist
  • Carlsbad, CA
  • NPI 1912184219
  Medicare reassignment Care Compare group NPD
• Advanced Psychological Associates & Wellness Center PC

  • Community/Behavioral Health Agency
  • Rancho Cucamonga, CA
  • NPI 1417262619
  NPD (past)
• New Horizons Therapy Group

  • Mental Health Counselor
  • Rancho Cucamonga, CA
  • NPI 1174050959
  NPD (past)

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

{
    "created_epoch": "1150934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537228800000",
    "number": "1174569453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10630 TOWN CENTER DR STE 120",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917306889",
            "telephone_number": "909-989-0901",
            "fax_number": "909-941-1087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10630 TOWN CENTER DR STE 120",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917306889",
            "telephone_number": "909-989-0901",
            "fax_number": "909-941-1087"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10722 Arrow Rte",
            "address_2": "314",
            "address_purpose": "LOCATION",
            "city": "Rancho Cucamonga",
            "state": "CA",
            "postal_code": "917304808",
            "country_code": "US",
            "telephone_number": "909-367-3333",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ETTELSON",
        "first_name": "RICHARD",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-22",
        "last_updated": "2018-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "D5418953",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Rancho Cucamonga, CA
• Providers in Rancho Cucamonga, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 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.

Verify at the official NPI Registry.