NPIMap

Organization Active NPI

Behavioral Health Associates Medical Group, Inc.

  • Psychologist
  • San Diego, CA
National Provider Identifier
1487703385
Registry record updated Nov 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
BEHAVIORAL HEALTH ASSOCIATES MEDICAL GROUP, INC.
Practice address
4542 Ruffner St
Suite 200
San Diego, CA 92111-2237
Phone
(619) 528-4600
Fax
(619) 528-4625
NPI assigned
Jan 9, 2007
Last updated
Nov 12, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2015

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

Authorized official

Name
Heather Gude, M.A.
Title
Credentialing Manager
Phone
(619) 528-4600

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X

Addresses

Primary practice location

4542 Ruffner St
Suite 200
San Diego, CA 92111-2237

Mailing address

4542 Ruffner St
Suite 200
San Diego, CA 92111-2237
Phone (619) 528-4600

National Provider Directory

National Provider Directory

Locations

4542 Ruffner St
Ste 200
San Diego, CA 92111
Phone 61952846006415

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447286400000",
    "number": "1487703385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4542 RUFFNER ST",
            "address_2": "SUITE 200",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921112237",
            "telephone_number": "619-528-4600",
            "fax_number": "619-528-4625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4542 RUFFNER ST",
            "address_2": "SUITE 200",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921112237",
            "telephone_number": "619-528-4600",
            "fax_number": "619-528-4625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEHAVIORAL HEALTH ASSOCIATES MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-09",
        "last_updated": "2015-11-12",
        "status": "A",
        "authorized_official_last_name": "GUDE",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "619-528-4600",
        "authorized_official_credential": "M.A."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.