Melbourne Medpsych PLLC

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

Legal business name

MELBOURNE MEDPSYCH PLLC

Practice address

1915 Oak Street
Melbourne, FL 32901

Phone

(540) 447-0134

Fax

(540) 932-7611

NPI assigned

Aug 1, 2022

Organization subpart

No

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

Authorized official

Name

Gerald R Showalter, PSY.D.NPI 1609847136

Title

MBR

Phone

(540) 447-0134

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gerald R Showalter, PSY.D

  • Clinical Psychologist
  • Waynesboro, VA
  • NPI 1609847136

  FL

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1659312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663027200000",
    "number": "1346977311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "406 AVENUE B",
            "city": "MELBOURNE BEACH",
            "state": "FL",
            "postal_code": "329512215",
            "telephone_number": "540-447-0134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1915 OAK STREET",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "32901",
            "telephone_number": "540-447-0134",
            "fax_number": "540-932-7611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MELBOURNE MEDPSYCH PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-01",
        "last_updated": "2022-09-13",
        "certification_date": "2022-09-13",
        "status": "A",
        "authorized_official_last_name": "SHOWALTER",
        "authorized_official_first_name": "GERALD",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MBR",
        "authorized_official_telephone_number": "540-447-0134",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA BOARD OF PSYCHOLOGY",
            "identifier": "PY10639",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Neuropsychologist in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Clinical Neuropsychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.