NPIMap

Organization Active NPI

Fred M. Sacks, PH.D. & Associates

  • Clinical Psychologist
  • Tipp City, OH
National Provider Identifier
1295088078
Registry record updated Oct 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
3768 Issued in OH
Legal business name
FRED M. SACKS, PH.D. & ASSOCIATES
Practice address
1485 Commerce Park Dr
Tipp City, OH 45371-2883
Phone
(937) 667-5126
Fax
(937) 667-7583
NPI assigned
Oct 18, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Fred M Sacks, PH.D.
Title
Owner / Psychologist
Phone
(937) 667-5126

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X 3768 OH Primary

Addresses

Primary practice location

1485 Commerce Park Dr
Tipp City, OH 45371-2883

Mailing address

1485 Commerce Park Dr
Tipp City, OH 45371-2883
Phone (937) 667-5126

Other identifiers 2

IdentifierTypeStateIssuer
0654635MedicaidOH
12836552300OtherOHBWC

Other names 1

  • Frederick Mark Sacks, Ph.D. Other name

National Provider Directory

National Provider Directory

Locations

1485 Commerce Park Dr
Tipp City, OH 45371
Phone (937) 667-5126

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1350518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350518400000",
    "number": "1295088078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1485 COMMERCE PARK DR",
            "city": "TIPP CITY",
            "state": "OH",
            "postal_code": "453712883",
            "telephone_number": "937-667-5126",
            "fax_number": "937-667-7583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1485 COMMERCE PARK DR",
            "city": "TIPP CITY",
            "state": "OH",
            "postal_code": "453712883",
            "telephone_number": "937-667-5126",
            "fax_number": "937-667-7583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRED M. SACKS, PH.D. & ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-18",
        "last_updated": "2012-10-18",
        "status": "A",
        "authorized_official_last_name": "SACKS",
        "authorized_official_first_name": "FRED",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER / PSYCHOLOGIST",
        "authorized_official_telephone_number": "937-667-5126",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "OH",
            "license": "3768",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0654635",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BWC",
            "identifier": "12836552300",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Frederick Mark Sacks, Ph.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Tipp City, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.