Kushanthi Surini Samaratunge, PSYD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

2628 Issued in OR

Practice address

7455 SW Beveland Rd
Tigard, OR 97223-8610

Phone

(503) 624-2600

Fax

(503) 624-7752

NPI assigned

Apr 10, 2008

Sex

Female

Sole proprietor

No

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 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

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Western Psychological and Counseling Services LLC

  • Clinical Psychologist
  • Tacoma, WA
  • NPI 1912008178

  OR

  Medicare reassignment NPD
• Serendib Psychological Services, LLC

  • Psychologist
  • Lake Oswego, OR
  • NPI 1275132979
  NPD Authorized official
• Western Psychological and Counseling Services LLC

  • Clinical Psychologist
  • Vancouver, WA
  • NPI 1629345731
  NPD

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

{
    "created_epoch": "1207785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437523200000",
    "number": "1265605133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7455 SW BEVELAND RD",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972238610",
            "telephone_number": "503-624-2600",
            "fax_number": "503-624-7752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7455 SW BEVELAND RD",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972238610",
            "telephone_number": "503-624-2600",
            "fax_number": "503-624-7752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMARATUNGE",
        "first_name": "KUSHANTHI",
        "middle_name": "SURINI",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-10",
        "last_updated": "2015-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OR",
            "license": "2628",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "210855",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ricardo Salazar
• Sadaf Saleem
• Melanie Salvador, FNP
• Lily Liu Sam, OD
• Malang Sama
• Ryan Todd Samples
• Robin Elizabeth San Miguel
• Nestor Sanchez de la Paz, LMT
• Exson Ismael Sanchez Lopez
• Dionne Sanchez

• Psychologist in Tigard, OR
• Providers in Tigard, OR by specialty
• Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2015; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.