Active NPI
Stephanie Smith
- Psychologist
- Alpine, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 30779
- Practice address
- 1620 Alpine Blvd
Alpine, CA 91901-1102 - Phone
- (619) 662-4100
- NPI assigned
- Mar 25, 2019
- Last updated
- Aug 4, 2023
- Sex
- Female
- Sole proprietor
- No
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 | 30779 | CA | Primary |
Addresses
Primary practice location
1620 Alpine Blvd
Alpine, CA 91901-1102
Mailing address
PO Box 2460
El Cajon, CA 92021-0460
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
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1620 Alpine Blvd
Suite 110
Alpine, CA 91901-1103
Phone (619) 662-4100
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30779 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Centro de Salud de la Comunidad de San Ysidro, Inc. | Current | Accepting new patients | |
| Centro de Salud de la Comunidad de San Ysidro Inc | Current | Accepting new patients | |
| Centro de Salud de la Comunidad de San Ysidro, Inc. | Current | Accepting new patients |
Locations
1620 Alpine Blvd
Ste 110
Alpine, CA 91901
Phone (760) 350-9725
1637 Third Ave
Ste B
Chula Vista, CA 91911
Phone (619) 425-1780
1136 D Ave
National City, CA 91950
Phone (619) 336-2300
1601 Precision Park Ln
San Ysidro, CA 92173
Phone (619) 205-4585
4004 Beyer Blvd
San Ysidro, CA 92173
Phone (619) 428-1330
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba San Ysidro Health Precision Park
- Federally Qualified Health Center (FQHC)
- San Diego, CA
- NPI 1124782685
-
dba San Ysidro Health Senior Dental Center
- Federally Qualified Health Center (FQHC)
- San Diego, CA
- NPI 1457033813
-
dba San Ysidro Health King-Chavez Health Center
- Federally Qualified Health Center (FQHC)
- San Diego, CA
- NPI 1538262092
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1553472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691107200000",
"number": "1346700325",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2460",
"city": "EL CAJON",
"state": "CA",
"postal_code": "920210460"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1620 ALPINE BLVD",
"city": "ALPINE",
"state": "CA",
"postal_code": "919011102",
"telephone_number": "619-662-4100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "STEPHANIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-03-25",
"last_updated": "2023-08-04",
"certification_date": "2023-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "30779",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Alpine, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2023; 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.