Individual provider Active NPI

Sophia Miller

  • Clinical Psychologist
  • Sacramento, CA
National Provider Identifier
1205553294
Registry record updated Aug 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
35287 Issued in CA
Practice address
1011 22ND St
Sacramento, CA 95816-4907
Phone
(916) 284-1416
NPI assigned
Oct 20, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 35287 CA Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

1011 22ND St
Sacramento, CA 95816-4907

Mailing address

1011 22ND St
Sacramento, CA 95816-4907
Phone (916) 284-1416

Other practice location 1

425 University Ave Ste 100
Sacramento, CA 95825-6508
Phone (916) 284-1416

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240910004225 CA Practitioner - Clinical Psychologist 1456891084 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2023
Medicare assignment
May accept Medicare assignment
Group practices
Vantage Point Center for PsychotherapyGroup PAC ID 0749518140, 13 clinicians

Practice addresses (Care Compare)

1011 22ND St
Sacramento, CA 95816-4907
Phone (916) 284-1416

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Dr. Trisha D Wallis, Psychologist, Apc Clinical CurrentSince Oct 1, 2022 Accepting new patients
Vantage Point Center for Psychotherapy CurrentSince Aug 28, 2024 Accepting new patients

Locations

1011 22nd St
Sacramento, CA 95816
Phone (916) 284-1416

425 University Ave
Ste 100
Sacramento, CA 95825
Phone (916) 284-1416

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1666224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724716800000",
    "number": "1205553294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 22ND ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958164907",
            "telephone_number": "916-284-1416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 22ND ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958164907",
            "telephone_number": "916-284-1416"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "425 University Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Sacramento",
            "state": "CA",
            "postal_code": "958256508",
            "country_code": "US",
            "telephone_number": "916-284-1416",
            "fax_number": "916-405-3539",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MILLER",
        "first_name": "SOPHIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-20",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "35287",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.