Andrew M. Prokopis, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY 20809 Issued in CA

Practice address

840 3Rd St
Santa Rosa, CA 95404-4502

Phone

(707) 292-1910

Fax

(707) 292-1910

NPI assigned

Jul 29, 2006

Last updated

Oct 20, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

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

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Mar 18, 2021 through Mar 18, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287532800000",
    "number": "1346254786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2537",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954732537",
            "telephone_number": "707-292-1910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 3RD ST",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954044502",
            "telephone_number": "707-292-1910",
            "fax_number": "707-292-1910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROKOPIS",
        "first_name": "ANDREW",
        "middle_name": "M.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-29",
        "last_updated": "2010-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NH",
            "license": "1061",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY 20809",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Progress Foundation
• Progress Foundation
• Progress Foundation (Progress Sonoma)
• Prohealth Home Care Inc
• Prohealth Home Care, Inc.
• Barbara Elizabeth Prosniewski, PH.D.
• Gail Prosser, RD, CDE
• Kenneth Frederick Prosser III, M.D.
• Providence in Home Health Care (Providential Fijian Home Care)
• Providence Medical Foundation

• Clinical Psychologist in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2010; 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.

Verify at the official NPI Registry.