NPIMap

Organization Active NPI

Jaime Elizabeth Medvene PHD a Professional Psychological Corpora

  • Clinical Psychologist
  • Agoura Hills, CA
National Provider Identifier
1306084272
Registry record updated May 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
CP13740 Issued in CA
Legal business name
JAIME ELIZABETH MEDVENE PHD A PROFESSIONAL PSYCHOLOGICAL CORPORA
Practice address
30200 Agoura Rd
Suite 190
Agoura Hills, CA 91301-5434
Phone
(818) 981-7845
NPI assigned
Jan 30, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2020

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

Authorized official

Name
Jaime Elizabeth Medvene, PHDNPI 1265478754
Title
President
Phone
(818) 981-7845

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X CP13740 CA Primary

Addresses

Primary practice location

30200 Agoura Rd
Suite 190
Agoura Hills, CA 91301-5434

Mailing address

30200 Agoura Rd
Suite 190
Agoura Hills, CA 91301-5434
Phone (818) 981-7845

Other identifiers 1

IdentifierTypeStateIssuer
PSY137401MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090312000135 CA Part B Supplier - Clinic/Group Practice 7911063201 Receives reassigned benefits from 9 practitioners
Practice locations: Agoura Hills, CA

National Provider Directory

National Provider Directory

Locations

30200 Agoura Rd
Ste 190
Agoura Hills, CA 91301
Phone (818) 981-7845

17337 Ventura Blvd
Ste 226
Encino, CA 91316
Phone (818) 808-0016

Practitioners & affiliated clinicians

Practitioners 11

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": "1233273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589500800000",
    "number": "1306084272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30200 AGOURA RD",
            "address_2": "SUITE 190",
            "city": "AGOURA HILLS",
            "state": "CA",
            "postal_code": "913015434",
            "telephone_number": "818-981-7845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30200 AGOURA RD",
            "address_2": "SUITE 190",
            "city": "AGOURA HILLS",
            "state": "CA",
            "postal_code": "913015434",
            "telephone_number": "818-981-7845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAIME ELIZABETH MEDVENE PHD A PROFESSIONAL PSYCHOLOGICAL CORPORA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-30",
        "last_updated": "2020-05-15",
        "certification_date": "2020-05-15",
        "status": "A",
        "authorized_official_last_name": "MEDVENE",
        "authorized_official_first_name": "JAIME",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-981-7845",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "CP13740",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PSY137401",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Agoura Hills, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.