Jeremy Blank, PSY.D.

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

PSY27148 Issued in CA

Practice address

27403 Ynez Rd Ste 205
Temecula, CA 92591-4616

Phone

(951) 595-7386

Fax

(951) 414-3770

NPI assigned

Sep 17, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Blank Psychological Services, Inc.

  • Adult Mental Health Clinic/Center
  • Temecula, CA
  • NPI 1487422747
  Medicare reassignment NPD Authorized official
• Martin Fleishman MD Inc

  • Psychiatry Physician
  • S.F., CA
  • NPI 1669511846
  NPD (past)
• Performance Psychology Center

  • Mental Health Counselor
  • Santa Rosa, CA
  • NPI 1982485413
  NPD (past)

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

{
    "created_epoch": "1253145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702684800000",
    "number": "1215260591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27403 YNEZ RD STE 205",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925914616",
            "telephone_number": "951-595-7386",
            "fax_number": "951-414-3770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27403 YNEZ RD STE 205",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925914616",
            "telephone_number": "951-595-7386",
            "fax_number": "951-414-3770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLANK",
        "first_name": "JEREMY",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-09-17",
        "last_updated": "2023-12-16",
        "certification_date": "2023-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY27148",
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CA",
            "license": "PSY27148",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Van Allen Black Jr.
• Katherine Marie Maclay Blackwell, LMFT
• Stephanie Blair, BCBA
• Blank Psychological Services, Inc.
• Emily Blank
• Hannah Bledsoe, RBT
• Jessica Marie-Pedroza Blevins, LMFT, ATR
• Brooke Lorraine Blomberg
• Joshua Aaron Blosser, DO
• Nichele Louise Blosser, DO

• Clinical Neuropsychologist in Temecula, CA
• Providers in Temecula, CA by specialty
• Clinical Neuropsychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2023; 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.