Active NPI
Kimberly Maceachern, PSYD
- Clinical Psychologist
- Everett, WA
National Provider Identifier
1588082077
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY60535554
- Practice address
- 309 Pecks Dr
Everett, WA 98203 - Phone
- (425) 362-4028
- NPI assigned
- Apr 1, 2014
- Sex
- Female
- Sole proprietor
- No
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 | PY60535554 | WA | Primary |
Addresses
Primary practice location
309 Pecks Dr
Everett, WA 98203
Mailing address
309 Pecks Dr
Everett, WA 98203
Phone (425) 362-4028
Other practice location 1
316 Main St Ste A4
Edmonds, WA 98020-3197
Phone (817) 793-2561
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- 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 |
|---|---|---|---|---|
| I20180212000663 | WA | Practitioner - Clinical Psychologist | 6709146814 | Practice locations: Everett, WA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
309 Pecks Dr
Everett, WA 98203-4410
Phone (425) 362-4028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY60535554 | WA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1396310400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1593561600000",
"number": "1588082077",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "309 PECKS DR",
"city": "EVERETT",
"state": "WA",
"postal_code": "98203",
"telephone_number": "425-362-4028"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "309 PECKS DR",
"city": "EVERETT",
"state": "WA",
"postal_code": "98203",
"telephone_number": "425-362-4028"
}
],
"practiceLocations": [
{
"address_1": "316 Main St Ste A4",
"address_purpose": "LOCATION",
"city": "Edmonds",
"state": "WA",
"postal_code": "980203197",
"country_code": "US",
"telephone_number": "817-793-2561",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MACEACHERN",
"first_name": "KIMBERLY",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-04-01",
"last_updated": "2020-07-01",
"certification_date": "2020-07-01",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WA",
"license": "PY60535554",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Everett, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2020; 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.