Charles Lavalle Page, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1404 Issued in CO

Practice address

149 W Harvard St
Suite 202
Fort Collins, CO 80525-2186

Phone

(970) 682-1173

Fax

(970) 282-1782

NPI assigned

Sep 23, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CO

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

Specialty

Clinical Psychologist

Education

Other, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1158969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477526400000",
    "number": "1467552059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "149 W HARVARD ST",
            "address_2": "SUITE 202",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805252186",
            "telephone_number": "970-682-1173",
            "fax_number": "970-282-1782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "149 W HARVARD ST",
            "address_2": "SUITE 202",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805252186",
            "telephone_number": "970-682-1173",
            "fax_number": "970-282-1782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAGE",
        "first_name": "CHARLES",
        "middle_name": "LAVALLE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-23",
        "last_updated": "2016-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CO",
            "license": "1404",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07014046",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113597000",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Madison Pachucy, MS CCC-SLP
• Bradley Packer, D.M.D
• Joseph Matthew Paddock, PA-S
• Raymond Padgett, CNIM
• Shawnea Pagat, PA-C
• Ellis Page
• Karin Elizabeth Brems Page, MS, OTR/L
• Joann Paille
• Krista A Paintner-Rudolph, DPT
• Jan Paisley, MD

• Clinical Psychologist in Fort Collins, CO
• Providers in Fort Collins, CO by specialty
• Clinical Psychologist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2016; 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.

Verify at the official NPI Registry.