Active NPI
Irwin S Rosenfarb
- Clinical Psychologist
- San Diego, CA
National Provider Identifier
1376731794
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 15174
- Practice address
- 10455 Pomerado Rd
Daley Hall 102B
San Diego, CA 92131-1717 - Phone
- (858) 635-4782
- NPI assigned
- Oct 10, 2007
- Sex
- Male
- 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 | 15174 | CA | Primary |
Addresses
Primary practice location
10455 Pomerado Rd
Daley Hall 102B
San Diego, CA 92131-1717
Mailing address
10455 Pomerado Rd
Daley Hall 102B
San Diego, CA 92131-1717
Phone (858) 635-4782
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220819001043 | CA | Practitioner - Psychologist Billing Independently | 5799168019 | Practice locations: San Diego, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1986
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
San Diego, CA 92131
Phone (858) 635-4782
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15174 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1191974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1191974400000",
"number": "1376731794",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10455 POMERADO RD",
"address_2": "DALEY HALL 102B",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921311717",
"telephone_number": "858-635-4782"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10455 POMERADO RD",
"address_2": "DALEY HALL 102B",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921311717",
"telephone_number": "858-635-4782"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSENFARB",
"first_name": "IRWIN",
"middle_name": "S",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-10-10",
"last_updated": "2007-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "15174",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.