NPIMap

Individual provider Active NPI

Caleb Mark Pearson, PSY.D.

  • Clinical Neuropsychologist
  • Phoenix, AZ
National Provider Identifier
1457471658
Registry record updated Apr 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
4200 Issued in AZ
Practice address
222 W Thomas Rd
Suite 315
Phoenix, AZ 85013-4419
Phone
(602) 406-3671
Fax
(602) 406-6115
NPI assigned
Mar 30, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X 4200 AZ Primary

Addresses

Primary practice location

222 W Thomas Rd
Suite 315
Phoenix, AZ 85013-4419

Mailing address

File 56765
Los Angeles, CA 90074-6765
Phone (602) 406-3860

Other identifiers 1

IdentifierTypeStateIssuer
639492MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140822000197 KS Practitioner - Clinical Psychologist 9638341886 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kansas University Physicians IncGroup PAC ID 8921911587, 1,809 clinicians

Practice addresses (Care Compare)

3901 Rainbow Blvd
Kansas City, KS 66160-0001
Phone (913) 588-6398

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.91 of 100Reported as apm
Quality
77.02
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4200AZMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Kansas University Physicians Inc CurrentSince Jul 1, 2017 Accepting new patients
Kansas University Physicians Inc CurrentSince Jul 1, 2017 Accepting new patients
University of Kansas Hospital Authority CurrentSince Sep 15, 2014 Accepting new patients
University of Kansas Hospital Authority CurrentSince Sep 15, 2014 Accepting new patients
Kansas University Physicians Inc Current Accepting new patients
Kansas University Physicians Inc Past Accepting new patients

Locations

3901 Rainbow Blvd
Kansas City, KS 66160
Phone (913) 588-6005

4000 Cambridge St
Kansas City, KS 66160
Phone (913) 588-0000

11300 Corporate Ave
Ste 330
Lenexa, KS 66219
Phone (913) 588-6111

Interoperability endpoints

  • Direct secure messaging: cpearson281186@direct.kuha.org

Organizations & group practices 6

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334620800000",
    "number": "1457471658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "FILE 56765",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900746765",
            "telephone_number": "602-406-3860",
            "fax_number": "602-406-6132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 W THOMAS RD",
            "address_2": "SUITE 315",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850134419",
            "telephone_number": "602-406-3671",
            "fax_number": "602-406-6115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEARSON",
        "first_name": "CALEB",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-30",
        "last_updated": "2012-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "AZ",
            "license": "4200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "639492",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.