Active NPI
Richard Alan Sobel, PHD
- Clinical Psychologist
- San Diego, CA
National Provider Identifier
1407902489
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY11279
- Practice address
- 5252 Balboa Ave
#802
San Diego, CA 92117 - Phone
- (858) 467-0170
- Fax
- (858) 467-0170
- NPI assigned
- Jan 25, 2007
- Sex
- Male
- Sole proprietor
- No
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 | PSY11279 | CA | Primary |
Addresses
Primary practice location
5252 Balboa Ave
#802
San Diego, CA 92117
Mailing address
5252 Balboa Ave
#802
San Diego, CA 92117
Phone (858) 467-0170
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| OPL112790 | Other | CA | BLUE SHIELD |
| PSY112790 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120109000396 | CA | Practitioner - Clinical Psychologist | 6406022771 | Practice locations: San Diego, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1987
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
5252 Balboa Ave
Suite 802
San Diego, CA 92117-6920
Phone (858) 467-0170
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY11279 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169683200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1407902489",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5252 BALBOA AVE",
"address_2": "#802",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "92117",
"telephone_number": "858-467-0170",
"fax_number": "858-467-0170"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5252 BALBOA AVE",
"address_2": "#802",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "92117",
"telephone_number": "858-467-0170",
"fax_number": "858-467-0170"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOBEL",
"first_name": "RICHARD",
"middle_name": "ALAN",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY11279",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "OPL112790",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PSY112790",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
- Michelle Soares, LPCC
- Anna M Sobal
- Peter Warren Soballe, M.D.
- Jennifer Leigh Sobel, L.AC.
- Mona Sobel, M.D.
- Stephen Victor Sobel, M.D.
- Sober Coaches of California LLC
- Sober Life Coach LLC
- Sober Life Recovery Solutions LLC (Hidden Leaf Wellness)
- Sober Life Recovery Solutions LLC (Healthy U Behavioral Health)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.