Active NPI
Mary Monique Rotert, PH.D.
- Clinical Psychologist
- Murrieta, CA
National Provider Identifier
1386789832
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 28409
- Practice address
- 40024 Via Xanthe
Murrieta, CA 92562-5568 - Phone
- (402) 490-1662
- Fax
- (760) 763-2222
- NPI assigned
- Feb 21, 2007
- Last updated
- Nov 12, 2022
- Sex
- Female
- 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 Psychologist | 103TC0700X | NE 429 | NE | |
| Clinical Psychologist | 103TC0700X | 28409 | CA | Primary |
Addresses
Primary practice location
40024 Via Xanthe
Murrieta, CA 92562-5568
Mailing address
40024 Via Xanthe
Murrieta, CA 92562-5568
Phone (402) 490-1662
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190220002690 | CA | Practitioner - Psychologist Billing Independently | 7214275056 | Practice locations: Murrieta, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1990
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
40024 VA Xanthe
Murrieta, CA 92562-5568
Phone (402) 490-1662
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NE 429 | NE | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172016000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1668211200000",
"number": "1386789832",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "40024 VIA XANTHE",
"city": "MURRIETA",
"state": "CA",
"postal_code": "925625568",
"telephone_number": "402-490-1662",
"fax_number": "760-763-2222"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "40024 VIA XANTHE",
"city": "MURRIETA",
"state": "CA",
"postal_code": "925625568",
"telephone_number": "402-490-1662",
"fax_number": "760-763-2222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROTERT",
"first_name": "MARY",
"middle_name": "MONIQUE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-21",
"last_updated": "2022-11-12",
"certification_date": "2022-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NE",
"license": "NE 429",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "28409",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Murrieta, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2022; 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.