Active NPI
Bobbi L Renderer, PH.D.
- Clinical Psychologist
- Upper Jay, NY
National Provider Identifier
1295719953
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 012414
- Practice address
- 48 Springfield Rd
Upper Jay, NY 12987-3204 - Phone
- (518) 586-4101
- NPI assigned
- Dec 5, 2005
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 012414 | NY | Primary |
Addresses
Primary practice location
48 Springfield Rd
Upper Jay, NY 12987-3204
Mailing address
48 Springfield Road
Upper Jay, NY 12987
Phone (518) 946-7487
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02430459 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090615000223 | NY | Practitioner - Clinical Psychologist | 4385794205 | Practice locations: Upper Jay, NY |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1993
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
12198 Route 9N
Suite 3
Upper Jay, NY 12987
Phone (518) 946-7487
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133740800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1650240000000",
"number": "1295719953",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "48 SPRINGFIELD ROAD",
"city": "UPPER JAY",
"state": "NY",
"postal_code": "12987",
"telephone_number": "518-946-7487"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "48 SPRINGFIELD RD",
"city": "UPPER JAY",
"state": "NY",
"postal_code": "129873204",
"telephone_number": "518-586-4101"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RENDERER",
"first_name": "BOBBI",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-12-05",
"last_updated": "2022-04-18",
"certification_date": "2022-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "012414",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02430459",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Upper Jay, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2022; 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.