Active NPI
Virginia Marie Crossleysmith, PSYD
- Clinical Psychologist
- Santa Rosa, CA
National Provider Identifier
1538130356
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 23799
- Practice address
- 1212 College Ave
Suite a
Santa Rosa, CA 95404-3908 - Phone
- (707) 431-7579
- Fax
- (707) 843-5095
- NPI assigned
- Jan 30, 2006
- Last updated
- Nov 1, 2017
- Sex
- Female
- 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 | 23799 | CA | Primary |
Addresses
Primary practice location
1212 College Ave
Suite a
Santa Rosa, CA 95404-3908
Mailing address
1308 Woodside CT
Healdsburg, CA 95448-3358
Phone (707) 431-7579
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 23799 | Other | CA | LICENSE NUMBER |
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 |
|---|---|---|---|---|
| I20130225000439 | CA | Practitioner - Clinical Psychologist | 6608021563 | Practice locations: Santa Rosa, 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)
1212 College Ave
Suite a
Santa Rosa, CA 95404-3977
Phone (707) 431-7579
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138579200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1509494400000",
"number": "1538130356",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1308 WOODSIDE CT",
"city": "HEALDSBURG",
"state": "CA",
"postal_code": "954483358",
"telephone_number": "707-431-7579",
"fax_number": "707-843-5095"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1212 COLLEGE AVE",
"address_2": "SUITE A",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954043908",
"telephone_number": "707-431-7579",
"fax_number": "707-843-5095"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CROSSLEYSMITH",
"first_name": "VIRGINIA",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-01-30",
"last_updated": "2017-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "23799",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE NUMBER",
"identifier": "23799",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2017; 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.