Individual provider Active NPI

Clifford Rambo Heegel, PH.D.

  • Counseling Psychologist
  • Memphis, TN
National Provider Identifier
1417992298
Registry record updated Dec 28, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Counseling PsychologistTaxonomy code 103TC1900X
License
P001687 Issued in TN
Practice address
4728 Spottswood Ave
#361
Memphis, TN 38117-4817
Phone
(901) 763-0999
NPI assigned
Jun 17, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 28, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counseling Psychologist 103TC1900X P001687 TN Primary

Addresses

Primary practice location

4728 Spottswood Ave
#361
Memphis, TN 38117-4817

Mailing address

4728 Spottswood Ave
#361
Memphis, TN 38117-4817
Phone (901) 763-0999

Other identifiers 2

IdentifierTypeStateIssuer
3688272MedicaidTN
P001687OtherTNPSYCHOLOGY LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060323000188 TN Practitioner - Clinical Psychologist 3678581253 Practice locations: Memphis, TN

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3784 Marion Ave
Memphis, TN 38111-6746
Phone (901) 763-0999

4728 Spottswood
Suite 361
Memphis, TN 38117-4817

4728 Spottswood Ave
Suite 361
Memphis, TN 38117-4817

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
P001687TNMDCounseling Psychologist

NPI Registry JSON

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

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1293494400000",
    "number": "1417992298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4728 SPOTTSWOOD AVE",
            "address_2": "#361",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381174817",
            "telephone_number": "901-763-0999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4728 SPOTTSWOOD AVE",
            "address_2": "#361",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381174817",
            "telephone_number": "901-763-0999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEEGEL",
        "first_name": "CLIFFORD",
        "middle_name": "RAMBO",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-17",
        "last_updated": "2010-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "TN",
            "license": "P001687",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3688272",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PSYCHOLOGY LICENSE",
            "identifier": "P001687",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.