NPIMap

Organization Active NPI

Progeny Psychiatric Clinic a Medical Corporation

  • Psychiatry Physician
  • Irvine, CA
National Provider Identifier
1548735202
Registry record updated Aug 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
PROGENY PSYCHIATRIC CLINIC A MEDICAL CORPORATION
Practice address
17782 Cowan Ste a
Irvine, CA 92614-6041
Phone
(949) 722-7118
Fax
(949) 396-0965
NPI assigned
Oct 9, 2018
Last updated
Aug 8, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2019

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

Authorized official

Name
Jason P Kellogg, MDNPI 1952331530
Title
Ceo
Phone
(949) 722-7118

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Neurology Physician 2084N0400X NU
Psychiatry Physician 2084P0800X NU Primary

Addresses

Primary practice location

17782 Cowan Ste a
Irvine, CA 92614-6041

Mailing address

17782 Cowan Ste a
Irvine, CA 92614-6041
Phone (949) 722-7118

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190919000593 CA Part B Supplier - Clinic/Group Practice 4688904592 Receives reassigned benefits from 40 practitioners
Practice locations: Irvine, CA; Westminster, CA; Long Beach, CA; Dana Point, CA; Huntington Beach, CA; Anaheim, CA

National Provider Directory

National Provider Directory

Locations

19671 Beach Blvd
Ste 442
Huntington Beach, CA 92648

Practitioners & affiliated clinicians

Practitioners 40

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1539043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565222400000",
    "number": "1548735202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17782 COWAN STE A",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926146041",
            "telephone_number": "949-722-7118",
            "fax_number": "949-396-0965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17782 COWAN STE A",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926146041",
            "telephone_number": "949-722-7118",
            "fax_number": "949-396-0965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROGENY PSYCHIATRIC CLINIC A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-09",
        "last_updated": "2019-08-08",
        "status": "A",
        "authorized_official_last_name": "KELLOGG",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "949-722-7118",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Irvine, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.