Individual provider Active NPI

Sharon Moerman Grodner, PH.D.

  • Clinical Psychologist
  • San Diego, CA
National Provider Identifier
1528105525
Registry record updated Nov 2, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY8039 Issued in CA
Practice address
2278 Pine St
San Diego, CA 92103-1153
Phone
(619) 977-6658
NPI assigned
Jan 31, 2007
Last updated
Nov 2, 2017By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 2, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY8039 CA Primary

Addresses

Primary practice location

2278 Pine St
San Diego, CA 92103-1153

Mailing address

2278 Pine St
San Diego, CA 92103-1153
Phone (619) 291-0219

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100928000582 CA Practitioner - Clinical Psychologist 1153447172 Practice locations: San Diego, CA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2278 Pine St
San Diego, CA 92103-1153
Phone (619) 977-6658

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY8039CAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
David S. Janowsky 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1509580800000",
    "number": "1528105525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2278 PINE ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921031153",
            "telephone_number": "619-291-0219",
            "fax_number": "619-297-7316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2278 PINE ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921031153",
            "telephone_number": "619-977-6658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRODNER",
        "first_name": "SHARON",
        "middle_name": "MOERMAN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-31",
        "last_updated": "2017-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY8039",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.