Active NPI
Roddy Suos, PSYD
- Clinical Psychologist
- Los Angeles, CA
National Provider Identifier
1174868434
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY26209
- Practice address
- 420 1/2 N Larchmont Blvd
Suite 2
Los Angeles, CA 90004-3014 - Phone
- (310) 800-1442
- NPI assigned
- Nov 27, 2012
- 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 | PSY26209 | CA | Primary |
Addresses
Primary practice location
420 1/2 N Larchmont Blvd
Suite 2
Los Angeles, CA 90004-3014
Mailing address
420 1/2 N Larchmont Blvd
Suite 2
Los Angeles, CA 90004-3014
Phone (310) 800-1442
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY26209 | CA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Heights Wellness, Inc | Clinical | Current | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinical Psychologist
- Long Beach, CA
- NPI 1639656036
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1353974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398729600000",
"number": "1174868434",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "420 1/2 N LARCHMONT BLVD",
"address_2": "SUITE 2",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900043014",
"telephone_number": "310-800-1442"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "420 1/2 N LARCHMONT BLVD",
"address_2": "SUITE 2",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900043014",
"telephone_number": "310-800-1442"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUOS",
"first_name": "RODDY",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-11-27",
"last_updated": "2014-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY26209",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2014; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.