Active NPI
Sandy M Bushberg, PH.D.
- Cognitive & Behavioral Psychologist
- Hood River, OR
National Provider Identifier
1487816310
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cognitive & Behavioral Psychologist
- License
- 1607
- Practice address
- 2230 Old Dalles Dr
Hood River, OR 97031-8533 - Phone
- (541) 380-0395
- Fax
- (541) 386-0078
- NPI assigned
- Jul 1, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1607 | OR | |
| Cognitive & Behavioral Psychologist | 103TB0200X | 1607 | OR | Primary |
| Clinical Psychologist | 103TC0700X | 1607 | OR | |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 1607 | OR |
Addresses
Primary practice location
2230 Old Dalles Dr
Hood River, OR 97031-8533
Mailing address
2230 Old Dalles Dr
Hood River, OR 97031-8533
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 218112 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1607 | OR | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mid-Columbia Medical Center | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Rural Health Clinic/Center
- The Dalles, OR
- NPI 1407887052
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1214870400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1252627200000",
"number": "1487816310",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2230 OLD DALLES DR",
"city": "HOOD RIVER",
"state": "OR",
"postal_code": "970318533"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2230 OLD DALLES DR",
"city": "HOOD RIVER",
"state": "OR",
"postal_code": "970318533",
"telephone_number": "541-380-0395",
"fax_number": "541-386-0078"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUSHBERG",
"first_name": "SANDY",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-07-01",
"last_updated": "2009-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "OR",
"license": "1607",
"primary": false
},
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "OR",
"license": "1607",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "1607",
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "OR",
"license": "1607",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "218112",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hood River, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.