Individual provider Active NPI

Erika Violet Kis, PHD

  • Clinical Psychologist
  • San Ramon, CA
National Provider Identifier
1265750137
Registry record updated Apr 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY 22828 Issued in CA
Practice address
111 Deerwood Rd Ste 200
San Ramon, CA 94583-4445
Phone
(925) 270-4499
Fax
(925) 270-4499
NPI assigned
May 17, 2010
Last updated
Apr 9, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2025

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 PSY 22828 CA Primary

Addresses

Primary practice location

111 Deerwood Rd Ste 200
San Ramon, CA 94583-4445

Mailing address

111 Deerwood Rd Ste 200
San Ramon, CA 94583-4445
Phone (925) 270-4499

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20100624000978 CA Practitioner - Clinical Psychologist 4284765942 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

111 Deerwood Rd
Suite 200
San Ramon, CA 94583-4445
Phone (925) 270-4499

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY 22828CAMDClinical Psychologist
22828CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Attentive Cognitive and Mental Health Services Psychology Inc. CurrentSince Jan 13, 2025 Accepting new patients

Locations

111 Deerwood Rd
Ste 200
San Ramon, CA 94583
Phone (925) 270-4499

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1274054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744156800000",
    "number": "1265750137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 DEERWOOD RD STE 200",
            "city": "SAN RAMON",
            "state": "CA",
            "postal_code": "945834445",
            "telephone_number": "925-270-4499",
            "fax_number": "925-270-4499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 DEERWOOD RD STE 200",
            "city": "SAN RAMON",
            "state": "CA",
            "postal_code": "945834445",
            "telephone_number": "925-270-4499",
            "fax_number": "925-270-4499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIS",
        "first_name": "ERIKA",
        "middle_name": "VIOLET",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-05-17",
        "last_updated": "2025-04-09",
        "certification_date": "2025-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY 22828",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Ramon, CA

Sources for this page

Verify at the official NPI Registry.