Individual provider Active NPI

Joel Edward Fick, PH.D.

  • Clinical Psychologist
  • Temecula, CA
National Provider Identifier
1366442527
Registry record updated May 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY17903 Issued in CA
Practice address
42145 Lyndie LN
Suite 102
Temecula, CA 92591-3612
Phone
(951) 699-4906
Fax
(951) 587-2625
NPI assigned
Jul 28, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 8, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 022908 NY
Clinical Psychologist 103TC0700X PSY17903 CA Primary

Addresses

Primary practice location

42145 Lyndie LN
Suite 102
Temecula, CA 92591-3612

Mailing address

PO Box 188
Livermore, CA 94551-0188
Phone (415) 528-9111

Other practice location 1

156 W 56th St Ste 1804
New York, NY 10019-3878
Phone (212) 851-8100

Other identifiers 1

IdentifierTypeStateIssuer
022908OtherNYSTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, NY2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20050808000278 CA Practitioner - Clinical Psychologist 6305875618 Reassigns benefits to 1 organization
I20260617001711 NY Practitioner - Clinical Psychologist 6305875618 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mellow Medical Inc a Professional CorporationGroup PAC ID 3375767403, 30 clinicians

Practice addresses (Care Compare)

8235 Santa Monica Blvd
Suite 302
West Hollywood, CA 90046-5969
Phone (888) 684-2779

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY17903CAMDClinical Psychologist
17903CAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Hlca, Inc. CurrentSince Sep 8, 2019 Accepting new patients
Mellow Medical Inc a Professional Corporation CurrentSince Feb 18, 2019 Accepting new patients
Clinical Psychassociates LLP Clinical PastSince Dec 11, 2017 Accepting new patients

Locations

12301 Wilshire Blvd
Ste 512
Los Angeles, CA 90025
Phone (833) 427-3566

4685 MacArthur Ct
Ste 340
Newport Beach, CA 92660
Phone (949) 424-4544

5201 Great America Pkwy
Ste 320
Santa Clara, CA 95054
Phone (323) 968-6182

8235 Santa Monica Blvd
Ste 302
West Hollywood, CA 90046
Phone (310) 892-4284

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/9357/brand/1/csg/1/fhir/r4
  • Direct secure messaging: joel.fick.2@9357.direct.athenahealth.com
  • Direct secure messaging: joel.fick.1@9357.direct.athenahealth.com

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1122508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557273600000",
    "number": "1366442527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 188",
            "city": "LIVERMORE",
            "state": "CA",
            "postal_code": "945510188",
            "telephone_number": "415-528-9111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42145 LYNDIE LN",
            "address_2": "SUITE 102",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925913612",
            "telephone_number": "951-699-4906",
            "fax_number": "951-587-2625"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "156 W 56th St Ste 1804",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100193878",
            "country_code": "US",
            "telephone_number": "212-851-8100",
            "fax_number": "212-537-0102",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FICK",
        "first_name": "JOEL",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-28",
        "last_updated": "2019-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "022908",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY17903",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "022908",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Temecula, CA

Sources for this page

Verify at the official NPI Registry.