Active NPI
John William Pehle, PHD
- Psychologist
- Modesto, CA
National Provider Identifier
1487680641
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY5304
- Practice address
- 1024 J St Ste 412
Modesto, CA 95354-0844 - Phone
- (209) 577-1159
- Fax
- (209) 823-8189
- NPI assigned
- Jun 22, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY5304 | CA | Primary |
Addresses
Primary practice location
1024 J St Ste 412
Modesto, CA 95354-0844
Mailing address
1024 J St Ste 412
Modesto, CA 95354-0844
Phone (209) 577-1159
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PSY053040 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101025000938 | CA | Practitioner - Psychologist Billing Independently | 3678766425 | Practice locations: Modesto, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY5304 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150934400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1487680641",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1024 J ST STE 412",
"city": "MODESTO",
"state": "CA",
"postal_code": "953540844",
"telephone_number": "209-577-1159",
"fax_number": "209-823-8189"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1024 J ST STE 412",
"city": "MODESTO",
"state": "CA",
"postal_code": "953540844",
"telephone_number": "209-577-1159",
"fax_number": "209-823-8189"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEHLE",
"first_name": "JOHN",
"middle_name": "WILLIAM",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-22",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY5304",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PSY053040",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.