Jason C Schickedanz

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY-203074 Issued in ID

Practice address

4737 Afton PL. Sanctuary NTC
Ste #a
Chubuck, ID 83202

Phone

(208) 417-0623

Fax

(208) 417-0641

NPI assigned

Aug 24, 2010

Last updated

Feb 27, 2023By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in ID

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, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

T HelpGroup PAC ID 9739319807, 3 clinicians

Practice addresses (Care Compare)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• T Help

  dba Sanctuary NTC

  • Community/Behavioral Health Agency
  • Chubbuck, ID
  • NPI 1649607250
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1282608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677456000000",
    "number": "1295041630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4737 AFTON PL. SANCTUARY NTC",
            "address_2": "STE #A",
            "city": "CHUBUCK",
            "state": "ID",
            "postal_code": "83202",
            "telephone_number": "208-417-0623",
            "fax_number": "208-417-0641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4737 AFTON PL. SANCTUARY NTC",
            "address_2": "STE #A",
            "city": "CHUBUCK",
            "state": "ID",
            "postal_code": "83202",
            "telephone_number": "208-417-0623",
            "fax_number": "208-417-0641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHICKEDANZ",
        "first_name": "JASON",
        "middle_name": "C",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-08-24",
        "last_updated": "2023-02-27",
        "certification_date": "2023-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "ID",
            "license": "PSY-203074",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2023; 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.