Active NPI
Kharis E. Powell, PH.D.
- Clinical Psychologist
- Lodi, CA
National Provider Identifier
1346305703
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY 13515
- Practice address
- 12 S Hutchins St
Lodi, CA 95240-1922 - Phone
- (209) 366-1822
- NPI assigned
- Dec 26, 2006
- 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 | PSY 13515 | CA | Primary |
Addresses
Primary practice location
12 S Hutchins St
Lodi, CA 95240-1922
Mailing address
12 S Hutchins St
Lodi, CA 95240-1922
Phone (209) 366-1822
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060127000502 | CA | Practitioner - Clinical Psychologist | 0143234252 | Practice locations: Lodi, CA; Stockton, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1991
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
755 S Fairmont Ave
Suite A2
Lodi, CA 95240-4643
Phone (209) 329-6349
800 S Ham LN
Lodi, CA 95242-3543
Phone (209) 368-7141
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 13515 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167091200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407888000000",
"number": "1346305703",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12 S HUTCHINS ST",
"city": "LODI",
"state": "CA",
"postal_code": "952401922",
"telephone_number": "209-366-1822"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12 S HUTCHINS ST",
"city": "LODI",
"state": "CA",
"postal_code": "952401922",
"telephone_number": "209-366-1822"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POWELL",
"first_name": "KHARIS",
"middle_name": "E.",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-26",
"last_updated": "2014-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY 13515",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lodi, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2014; 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.