Active NPI
Mark Charles Duris, PH.D.
- Clinical Psychologist
- Tacoma, WA
National Provider Identifier
1437322096
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY00003723
- Practice address
- 9040 Reid St # a
Tacoma, WA 98431-1101 - Phone
- (253) 968-3162
- Fax
- (253) 968-3278
- NPI assigned
- Apr 3, 2008
- 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 | PY00003723 | WA | Primary |
Addresses
Primary practice location
9040 Reid St # a
Tacoma, WA 98431-1101
Mailing address
9040 Reid St # a
Tacoma, WA 98431-1101
Phone (253) 968-3162
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- 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 |
|---|---|---|---|---|
| I20130423000341 | WA | Practitioner - Clinical Psychologist | 2961648712 | Practice locations: Lakewood, WA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
9115 Bridgeport Way SW
Lakewood, WA 98499-2449
Phone (253) 581-0700
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY00003723 | WA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1207180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1207180800000",
"number": "1437322096",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9040 REID ST # A",
"city": "TACOMA",
"state": "WA",
"postal_code": "984311101",
"telephone_number": "253-968-3162",
"fax_number": "253-968-3278"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9040 REID ST # A",
"city": "TACOMA",
"state": "WA",
"postal_code": "984311101",
"telephone_number": "253-968-3162",
"fax_number": "253-968-3278"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DURIS",
"first_name": "MARK",
"middle_name": "CHARLES",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-04-03",
"last_updated": "2008-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WA",
"license": "PY00003723",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2008; 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.