Active NPI
Marc Borkheim, PHD
- Clinical Psychologist
- Los Angeles, CA
National Provider Identifier
1386766095
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 22988
- Practice address
- 864 S Robertson Blvd Ste 104
Los Angeles, CA 90035-1622 - Phone
- (617) 304-5256
- NPI assigned
- Apr 4, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | 22988 | CA | |
| Clinical Psychologist | 103TC0700X | 22988 | CA | Primary |
Addresses
Primary practice location
864 S Robertson Blvd Ste 104
Los Angeles, CA 90035-1622
Mailing address
10990 Rochester Ave
312
Los Angeles, CA 90024-6274
Phone (617) 304-5256
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130510000389 | CA | Practitioner - Psychologist Billing Independently | 5991942971 | Practice locations: Los Angeles, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
1180 S Beverly Dr
Suite 608
Los Angeles, CA 90035-1158
Phone (617) 304-5256
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1681862400000",
"number": "1386766095",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10990 ROCHESTER AVE",
"address_2": "312",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900246274",
"telephone_number": "617-304-5256"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "864 S ROBERTSON BLVD STE 104",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900351622",
"telephone_number": "617-304-5256"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BORKHEIM",
"first_name": "MARC",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-04",
"last_updated": "2023-04-19",
"certification_date": "2023-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "CA",
"license": "22988",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "22988",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2023; 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.