Active NPI
Ahmed Kamil Jibril, PSYD.
- Clinical Psychologist
- Oakland, CA
National Provider Identifier
1487857348
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY27036
- Practice address
- 4200 Park Blvd # 106
Oakland, CA 94602-1312 - Phone
- (510) 269-0424
- NPI assigned
- Jun 7, 2007
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY27036 | CA | Primary |
Addresses
Primary practice location
4200 Park Blvd # 106
Oakland, CA 94602-1312
Mailing address
4200 Park Blvd # 106
Oakland, CA 94602-1312
Phone (510) 269-0424
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230309001354 | CA | Practitioner - Clinical Psychologist | 9739552928 | Practice locations: Oakland, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
Oakland, CA 94610
Phone (510) 269-0424
1216 E 34TH St
Oakland, CA 94610-2816
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY27036 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1732233600000",
"number": "1487857348",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4200 PARK BLVD # 106",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946021312",
"telephone_number": "510-269-0424"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4200 PARK BLVD # 106",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946021312",
"telephone_number": "510-269-0424"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JIBRIL",
"first_name": "AHMED",
"middle_name": "KAMIL",
"name_prefix": "Mr.",
"credential": "PSYD.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-06-07",
"last_updated": "2024-11-22",
"certification_date": "2024-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY27036",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 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.