Katherine Shadish, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

30634 Issued in CA

Practice address

222 W 39TH Ave
San Mateo, CA 94403-4364

Phone

(408) 975-2730

NPI assigned

Jun 26, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

County of San MateoGroup PAC ID 9032023171, shared by 15 NPIs, 316 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• County of San Mateo

  • Multi-Specialty Clinic/Center
  • San Mateo, CA
  • NPI 1679642326
  Medicare reassignment NPD
• County of San Mateo

  • Multi-Specialty Clinic/Center
  • San Mateo, CA
  • NPI 1831268580
  Medicare reassignment NPD
• County of San Mateo

  • Psychiatric Hospital Unit
  • San Mateo, CA
  • NPI 1144309055
  NPD
• County of San Mateo

  • Community/Behavioral Health Agency
  • Redwood City, CA
  • NPI 1528432481
  NPD

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

{
    "created_epoch": "1372204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547510400000",
    "number": "1336589043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 W 39TH AVE",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944034364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 W 39TH AVE",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944034364",
            "telephone_number": "408-975-2730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHADISH",
        "first_name": "KATHERINE",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-26",
        "last_updated": "2019-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "30634",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Glenn Setiono
• Lori K Severais, P.T.
• Mayrendy Fabiola Severino Medina
• Holly Severson, R.N.
• McKenna R Shade
• Marisa Dawn Shaff
• Hema A Shah, MD
• Robyn Shalinsky
• Zaynab Shamsan
• Mona Shamshikh

• Clinical Psychologist in San Mateo, CA
• Providers in San Mateo, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2019; 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.

Verify at the official NPI Registry.