Marc Anthony Campos-Pantoja, LCSW, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

94028409 Issued in CA

Practice address

9412 Big Horn Blvd Ste 6
Elk Grove, CA 95758-1101

Phone

(916) 226-2812

NPI assigned

Dec 12, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Other names 1

• Mr. Marc Anthony Campos-Ramos Former name

Medicare fee-for-service enrollment

Enrolled in CA

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 Social Worker

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Cyti Health PC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • San Diego, CA
  • NPI 1679172290
  Medicare reassignment NPD
• Forward Wellness Family Therapy, Inc.

  • Community/Behavioral Health Agency
  • Placentia, CA
  • NPI 1093398059
  Medicare reassignment NPD
• Fresno Youth Care Homes, Inc.

  • Mental Illness Community Based Residential Treatment Facility
  • Fresno, CA
  • NPI 1033875885
  NPD (past)

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724630400000",
    "number": "1487715785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22539 2ND ST",
            "city": "HAYWARD",
            "state": "CA",
            "postal_code": "945414111",
            "telephone_number": "510-886-2485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9412 BIG HORN BLVD STE 6",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957581101",
            "telephone_number": "916-226-2812"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5271 W Palo Alto Ave",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937223635",
            "country_code": "US",
            "telephone_number": "559-276-2331",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "64 E Weldon Ave",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937045956",
            "country_code": "US",
            "telephone_number": "559-276-2331",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CAMPOS-PANTOJA",
        "first_name": "MARC",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "LCSW, PSYD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-12",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "ASW 14648",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "25797",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "94028409",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARC",
            "last_name": "CAMPOS-RAMOS",
            "middle_name": "ANTHONY",
            "prefix": "MR.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jade Camp-Villalovos
• Audrey Campbell
• Jennifer Campbell
• Victoria Campbell
• Jenifer Campos-Gonzalez
• Fabiola Campos
• Morgan Candia
• Cassaundra Canfield
• Scott C Cannon, MD
• Candace Cantillo

• Clinical Psychologist in Elk Grove, CA
• Providers in Elk Grove, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2024; 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.