Active NPI
Phyllis M Richardson, PH.D.
- Clinical Psychologist
- Portland, OR
National Provider Identifier
1558425926
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 668
- Practice address
- 1112 NE 21St Ave
Suite 5
Portland, OR 97232-2595 - Phone
- (503) 281-1897
- Fax
- (503) 281-4862
- NPI assigned
- Dec 20, 2006
- Last updated
- Dec 19, 2007
- 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 | 668 | OR | Primary |
Addresses
Primary practice location
1112 NE 21St Ave
Suite 5
Portland, OR 97232-2595
Mailing address
1112 NE 21St Ave
Suite 5
Portland, OR 97232
Phone (503) 281-1897
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 164936 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- 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 |
|---|---|---|---|---|
| I20080306000041 | OR | Practitioner - Clinical Psychologist | 2567547227 | Practice locations: Portland, OR |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1984
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
1112 NE 21St Ave
Suite 5
Portland, OR 97232-2595
Phone (503) 281-1897
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 668 | OR | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166572800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1198022400000",
"number": "1558425926",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1112 NE 21ST AVE",
"address_2": "SUITE 5",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97232",
"telephone_number": "503-281-1897",
"fax_number": "503-281-4862"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1112 NE 21ST AVE",
"address_2": "SUITE 5",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972322595",
"telephone_number": "503-281-1897",
"fax_number": "503-281-4862"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RICHARDSON",
"first_name": "PHYLLIS",
"middle_name": "M",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-20",
"last_updated": "2007-12-19",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "668",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "164936",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2007; 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.