Mikala Saccoman, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

Practice address

497 SW Century Dr
Ste 104
Bend, OR 97702-1167

Phone

(541) 678-5174

NPI assigned

Dec 14, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Mikala L. Saccoman, PHD, LLC

  • Psychologist
  • Bend, OR
  • NPI 1164180683
  NPD Authorized official
• Connected Cognition LLC

  • Clinical Neuropsychologist
  • Bend, OR
  • NPI 1124661152
  NPD (past)

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

{
    "created_epoch": "1323820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453161600000",
    "number": "1396014759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "497 SW CENTURY DR",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977021167",
            "telephone_number": "541-678-5174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "497 SW CENTURY DR",
            "address_2": "STE 104",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977021167",
            "telephone_number": "541-678-5174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SACCOMAN",
        "first_name": "MIKALA",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-12-14",
        "last_updated": "2016-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500647410",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "R166086",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael G Ryan, MD
• Susan Lee Ryberg, L.AC.
• Andrew Joseph Sabatier, DPT
• Matt Sabelman
• Matthew Sabongi, D.O.
• Nichole Saccurato
• Jason Sadora
• Safe Haven Care, Inc.
• Safe Journey Counseling LLC
• Safeway Inc

• Psychologist in Bend, OR
• Providers in Bend, OR by specialty
• Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.