Jason C Schickedanz
Individual provider Active NPI Psychologist · Chubuck, ID
NPI 1295041630 · NPPES record last updated Feb 27, 2023
Key facts
- NPI
- 1295041630
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- PSY-203074 (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
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- T Help
Practice addresses (Care Compare)
4737 S Afton PL
Suite a
Chubbuck, ID 83202-2317
Phone (208) 417-0623
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200224001604 | ID | Practitioner - Clinical Psychologist | 5799112249 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY-203074 | ID | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| T Help | Current |
Accepting new patients |
Locations
4737 S Afton Pl
#A
Pocatello, ID 83202
Phone (208) 251-4951
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY-203074 | ID | Yes |
Addresses
Primary practice location
4737 Afton PL. Sanctuary NTC
Ste #a
Chubuck, ID 83202
Mailing address
4737 Afton PL. Sanctuary NTC
Ste #a
Chubuck, ID 83202
Phone (208) 417-0623
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 27, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.