Active NPI
Gregg Selke, PH.D.
- Clinical Neuropsychologist
- Providence, RI
National Provider Identifier
1447458708
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- PS01024
- Practice address
- 593 Eddy St
Pob 430
Providence, RI 02903-4923 - Phone
- (401) 444-4500
- Fax
- (401) 444-6643
- NPI assigned
- Jul 10, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | PS01024 | RI | Primary |
| Clinical Psychologist | 103TC0700X | PS01024 | RI |
Addresses
Primary practice location
593 Eddy St
Pob 430
Providence, RI 02903-4923
Mailing address
593 Eddy St
Potter 3
Providence, RI 02903-4923
Phone (401) 444-4318
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PS01024 | Other | RI | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS01024 | RI | MD | Clinical Neuropsychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rhode Island Hospital | Past | Accepting new patients | |
| Lifespan Physician Group, Inc. | Clinical Neuropsychologist | Past | Accepting new patients |
| Emma Pendleton Bradley Hospital | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Psychiatric Hospital
- East Providence, RI
- NPI 1225017486
-
- Psychiatry Physician
- Providence, RI
- NPI 1548506793
Clinical Neuropsychologist
-
- General Acute Care Hospital
- Providence, RI
- NPI 1972768174
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184025600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1360022400000",
"number": "1447458708",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "593 EDDY ST",
"address_2": "POTTER 3",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029034923",
"telephone_number": "401-444-4318",
"fax_number": "401-444-6573"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "593 EDDY ST",
"address_2": "POB 430",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029034923",
"telephone_number": "401-444-4500",
"fax_number": "401-444-6643"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SELKE",
"first_name": "GREGG",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-07-10",
"last_updated": "2013-02-05",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "RI",
"license": "PS01024",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "RI",
"license": "PS01024",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "PS01024",
"state": "RI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Providence, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.