Jason Bird, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

3627 Issued in CT

Practice address

15720 Brixham Hill Avenue
150
Charlotte, NC 28227

Phone

(704) 970-4791

NPI assigned

Oct 30, 2017

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Bird Psychological Group PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Charlotte, NC
  • NPI 1962261404
  NPD Authorized official
• Southeastpsych Ballantyne, PLLC

  • Psychologist
  • Charlotte, NC
  • NPI 1902318249
  NPD (past)

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

{
    "created_epoch": "1509321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1509321600000",
    "number": "1205348281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 HOBCAW DR",
            "city": "GREER",
            "state": "SC",
            "postal_code": "296504416",
            "telephone_number": "864-905-8195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15720 BRIXHAM HILL AVENUE",
            "address_2": "150",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28227",
            "telephone_number": "704-970-4791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BIRD",
        "first_name": "JASON",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-10-30",
        "last_updated": "2017-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CT",
            "license": "3627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chelsea Leander Birch, ND
• Michele Noele Birch, MD
• Bird Psychological Group PLLC
• Amber Bird, BCBA
• Camilla Bird
• Kimberly D. Bird, MSW
• Laura Lily Bird, PA
• Sarah P Bird, PMHNP-BC
• Suzanne Elizabeth Bird, DDS, MS
• Barbara Blackmore Birge, PHD, LPC, NCC

• All providers in Charlotte, NC
• Clinical Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.