Spokane Psychiatric Clinic PS

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

MD00015837 Issued in WA

Legal business name

SPOKANE PSYCHIATRIC CLINIC PS

Practice address

105 W 8TH Ave
6055
Spokane, WA 99204

Phone

(509) 455-9090

Fax

(509) 747-2118

NPI assigned

Dec 21, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jerene G Rockstrom

Title

Office Manager

Phone

(509) 455-9090

Specialties & licenses 5

Addresses

Other identifiers 6

Locations

Practitioners 1

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.

• David G. Grubb, M.D.

  • Psychiatry Physician
  • Spokane, WA
  • NPI 1114127412
  NPD (past)

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

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1235293473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 W 8TH AVE",
            "address_2": "6055",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "99204",
            "telephone_number": "509-455-9090",
            "fax_number": "509-747-2118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 W 8TH AVE",
            "address_2": "6055",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "99204",
            "telephone_number": "509-455-9090",
            "fax_number": "509-747-2118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPOKANE PSYCHIATRIC CLINIC PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ROCKSTROM",
        "authorized_official_first_name": "JERENE",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "509-455-9090"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WA",
            "license": "MD00017775",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WA",
            "license": "MD00019775",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WA",
            "license": "MD00018006",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WA",
            "license": "MD00021497",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WA",
            "license": "MD00015837",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1077791",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1077817",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L & I",
            "identifier": "0034874",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1077775",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1080191",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1077783",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Spokane Orthopedics PLLC
• Spokane Outpatient Anesthesia PLLC
• Spokane Pediatrics PLLC
• Spokane Physician Services, a Professional LLC
• Spokane Plastic Surgeons PS (Spokane Plastic Surgeons Surgicenter)
• Spokane Psychiatry and Psychology, P.S.
• Spokane Psychology and Neuropsychology, PS
• Spokane Public Schools District 81
• Spokane Radiology Consultants, PS
• Spokane Regional Health District

• Psychiatry Physician in Spokane, WA
• Providers in Spokane, WA by specialty
• Psychiatry Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.