NPIMap

Organization Active NPI

Krop-Neidigh PA

Doing business as Community Behavioral Services

  • Psychologist
  • Orange Park, FL
National Provider Identifier
1225197544
Registry record updated May 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PY4090 Issued in FL
Legal business name
KROP-NEIDIGH PA
Doing business as
Community Behavioral Services
Practice address
1543 Kingsley Ave
Suite 18a
Orange Park, FL 32073-4535
Phone
(904) 269-3324
Fax
(904) 264-2302
NPI assigned
Dec 6, 2006
Last updated
May 16, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2012

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

Authorized official

Name
Larry NeidighNPI 1508831322
Title
Clinical Director
Phone
(904) 269-3324

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PY4090 FL Primary

Addresses

Primary practice location

1543 Kingsley Ave
Suite 18a
Orange Park, FL 32073-4535

Mailing address

1543 Kingsley Ave
Suite 18a
Orange Park, FL 32073-4535
Phone (904) 269-3324

Other names 1

  • Community Behavioral Services Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120604000269 FL Part B Supplier - Clinic/Group Practice 1658535695 Receives reassigned benefits from 3 practitioners
Practice locations: Jacksonville, FL; Orange Park, FL

National Provider Directory

National Provider Directory
Tax ID family
Community Behavioral Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2111 Park St
Jacksonville, FL 32204

2211 Park St
Jacksonville, FL 32204
Phone (904) 269-3324

1543 Kingsley Ave
Ste 18A
Orange Park, FL 32073
Phone (904) 269-3324

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337126400000",
    "number": "1225197544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1543 KINGSLEY AVE",
            "address_2": "SUITE 18A",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734535",
            "telephone_number": "904-269-3324",
            "fax_number": "904-264-2302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1543 KINGSLEY AVE",
            "address_2": "SUITE 18A",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734535",
            "telephone_number": "904-269-3324",
            "fax_number": "904-264-2302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KROP-NEIDIGH PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2012-05-16",
        "status": "A",
        "authorized_official_last_name": "NEIDIGH",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "904-269-3324"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY4090",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Behavioral Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orange Park, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.