Active NPI
Samantha Miller, PSYD
- Clinical Psychologist
- Pasadena, CA
National Provider Identifier
1447817010
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY30998
- Practice address
- 107 S Fair Oaks Ave Ste 219
Pasadena, CA 91105-2082 - Phone
- (626) 600-6346
- NPI assigned
- May 20, 2019
- Sex
- Female
- 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 | PSY30998 | CA | Primary |
Addresses
Primary practice location
107 S Fair Oaks Ave Ste 219
Pasadena, CA 91105-2082
Mailing address
107 S Fair Oaks Ave Ste 219
Pasadena, CA 91105-2082
Phone (626) 600-6346
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jun 26, 2019 through Jun 26, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY30998 | CA | MD | Clinical Psychologist |
| 30998 | CA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1558310400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1596412800000",
"number": "1447817010",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "107 S FAIR OAKS AVE STE 219",
"city": "PASADENA",
"state": "CA",
"postal_code": "911052082",
"telephone_number": "626-600-6346"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "107 S FAIR OAKS AVE STE 219",
"city": "PASADENA",
"state": "CA",
"postal_code": "911052082",
"telephone_number": "626-600-6346"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "SAMANTHA",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-05-20",
"last_updated": "2020-08-03",
"certification_date": "2020-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY30998",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pasadena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2020; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.