NPIMap

Organization Active NPI

Utah State University

  • Psychologist
  • Logan, UT
National Provider Identifier
1386776730
Registry record updated Jun 8, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
UTAH STATE UNIVERSITY
Practice address
2810 Old Main HL
Logan, UT 84322
Phone
(435) 797-3401
Fax
(435) 797-1448
NPI assigned
Mar 12, 2007
Last updated
Jun 8, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
UTAH STATE UNIVERSIRYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 8, 2018

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

Authorized official

Name
Sue Reeder
Title
Billing Lead
Phone
(435) 797-1346

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X NU Primary
Clinical Psychologist 103TC0700X NU
Clinical Child & Adolescent Psychologist 103TC2200X NU

Addresses

Primary practice location

2810 Old Main HL
Logan, UT 84322

Mailing address

6405 Old Main HL
Logan, UT 84322-6405
Phone (435) 797-1346

Other names 1

  • USU Psychology Community Clinic Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120508000468 UT Part B Supplier - Clinic/Group Practice 3476715491 Receives reassigned benefits from 18 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Logan, UT

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Utah State University Center for Persons With Disabilities

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528416000000",
    "number": "1386776730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6405 OLD MAIN HL",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843226405",
            "telephone_number": "435-797-1346",
            "fax_number": "435-797-1448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2810 OLD MAIN HL",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "84322",
            "telephone_number": "435-797-3401",
            "fax_number": "435-797-1448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UTAH STATE UNIVERSITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "UTAH STATE UNIVERSIRY",
        "enumeration_date": "2007-03-12",
        "last_updated": "2018-06-08",
        "status": "A",
        "authorized_official_last_name": "REEDER",
        "authorized_official_first_name": "SUE",
        "authorized_official_title_or_position": "BILLING LEAD",
        "authorized_official_telephone_number": "435-797-1346"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "USU Psychology Community Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "USU Psychology Community Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Logan, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2018; 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.