Individual provider Active NPI

Farzana Siddiqui, PSY.D

  • Clinical Psychologist
  • Beaverton, OR
National Provider Identifier
1255563524
Registry record updated Mar 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
2671 Issued in OR
Practice address
1500 NW Bethany Blvd Ste 320
Beaverton, OR 97006-5238
Phone
(503) 567-3260
NPI assigned
Aug 20, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 13, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 2671 OR Primary

Addresses

Primary practice location

1500 NW Bethany Blvd Ste 320
Beaverton, OR 97006-5238

Mailing address

1500 NW Bethany Blvd Ste 320
Beaverton, OR 97006-5238
Phone (503) 567-3260

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20160322002556 OR Practitioner - Clinical Psychologist 4587961313 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1500 NW Bethany Blvd
Suite 320
Beaverton, OR 97006-5238
Phone (503) 567-3260

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2671ORMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Western Psychological and Counseling Services LLC Clinical CurrentSince Mar 1, 2016 Accepting new patients
Western Psychological and Counseling Services LLC Clinical CurrentSince Mar 1, 2016 Accepting new patients

Locations

1500 NW Bethany Blvd
Ste 320
Beaverton, OR 97006
Phone (503) 567-3260

880 82nd Dr
Gladstone, OR 97027
Phone (503) 626-9494

Interoperability endpoints

  • Direct secure messaging: lifestancehealth.farzanasiddiqui@148835.advancedmd-direct.com

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": "1250726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489363200000",
    "number": "1255563524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 NW BETHANY BLVD STE 320",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970065238",
            "telephone_number": "503-567-3260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 NW BETHANY BLVD STE 320",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970065238",
            "telephone_number": "503-567-3260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDDIQUI",
        "first_name": "FARZANA",
        "name_prefix": "Dr.",
        "credential": "PSY.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-08-20",
        "last_updated": "2017-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "2671",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaverton, OR

Sources for this page

Verify at the official NPI Registry.