The Memory Doctor, LLC

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

PY6497 Issued in FL

Legal business name

THE MEMORY DOCTOR, LLC

Practice address

26540 Ace Ave Ste E-106
Leesburg, FL 34748-8279

Phone

(352) 530-2170

Fax

(352) 530-2180

NPI assigned

Jun 1, 2005

Last updated

Mar 29, 2021By 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

Brenda Mason

Title

Office Manager

Phone

(352) 530-2170

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 2

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.

• Douglas J Mason, PSYD

  • Clinical Neuropsychologist
  • Leesburg, FL
  • NPI 1750383006
  Medicare reassignment NPD
• Richard J Field III, MD

  • Surgery Physician
  • Centreville, MS
  • NPI 1548217847
  NPD (past)

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

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616976000000",
    "number": "1265434534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26540 ACE AVE STE E-106",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347488279",
            "telephone_number": "352-530-2170",
            "fax_number": "352-530-2180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26540 ACE AVE STE E-106",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347488279",
            "telephone_number": "352-530-2170",
            "fax_number": "352-530-2180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE MEMORY DOCTOR, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-01",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A",
        "authorized_official_last_name": "MASON",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "352-530-2170"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "FL",
            "license": "PY6497",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY6497",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chimeshia Thomas
• Claudia L Thomas, M.D.
• Jolly Thomas, M.D.
• Katie Leigh Thomas, DC

• Clinical Neuropsychologist in Leesburg, FL
• Providers in Leesburg, FL by specialty
• Clinical Neuropsychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2021; 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.