Active NPI
Alex J Ricketts, PHD
- Psychologist
- Beaverton, OR
National Provider Identifier
1336162353
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1638
- Practice address
- 16110 SW Regatta LN
Beaverton, OR 97006-8942 - Phone
- (503) 533-7166
- Fax
- (503) 533-4433
- NPI assigned
- Jul 25, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1638 | OR | Primary |
Addresses
Primary practice location
16110 SW Regatta LN
Beaverton, OR 97006-8942
Mailing address
16110 SW Regatta LN
Beaverton, OR 97006-8942
Phone (503) 533-7166
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Apr 1, 2017 through Apr 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1638 | OR | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1659312000000",
"number": "1336162353",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16110 SW REGATTA LN",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970068942",
"telephone_number": "503-533-7166",
"fax_number": "503-230-1541"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16110 SW REGATTA LN",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970068942",
"telephone_number": "503-533-7166",
"fax_number": "503-533-4433"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RICKETTS",
"first_name": "ALEX",
"middle_name": "J",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-25",
"last_updated": "2022-08-01",
"certification_date": "2022-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "OR",
"license": "1638",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beaverton, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.