Jeffrey Grant Wilson, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY12832 Issued in CA

Practice address

27725 Santa Margarita Pkwy
Suite 215
Mission Viejo, CA 92691-6704

Phone

(949) 272-3870

Fax

(949) 951-2802

NPI assigned

Jun 1, 2006

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

Other identifiers 1

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, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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.

• Gary J Schummer PHD Apc

  dba ADD Treatment Center

  • Clinical Psychologist
  • Torrance, CA
  • NPI 1942237938
  NPD (past)
• Gary J. Schummer, Apc

  dba ADD Treatment Center

  • Clinical Psychologist
  • Mission Viejo, CA
  • NPI 1942246582
  NPD (past)
• Pmni, Inc.

  • Clinical Neurophysiology Physician
  • Rolling Hills Estates, CA
  • NPI 1811456478
  NPD (past)

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258761600000",
    "number": "1245277979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27725 SANTA MARGARITA PKWY",
            "address_2": "SUITE 215",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926916704",
            "telephone_number": "949-272-3870",
            "fax_number": "929-951-2802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27725 SANTA MARGARITA PKWY",
            "address_2": "SUITE 215",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926916704",
            "telephone_number": "949-272-3870",
            "fax_number": "949-951-2802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JEFFREY",
        "middle_name": "GRANT",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-01",
        "last_updated": "2009-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY12832",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP ID",
            "identifier": "W19141A",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erica Wilmot, SLP
• Julie Wilnier, PHD
• Amber Michelle Wilridge
• Cherie M Wilson, O.D.
• Danielle Renee Wilson, DPT
• Joseph W Wilson, D.D.S.
• Genevieve Wimber, LM, CPM
• Randall Dean Winchell, DC
• Robert Henry Winokur, M.D.
• Quintin C Wise

• Clinical Psychologist in Mission Viejo, CA
• Providers in Mission Viejo, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2009; 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.