Active NPI
Kevin Sean Bunch, PSY D.
- Clinical Psychologist
- Martinez, CA
National Provider Identifier
1588715155
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY24580
- Practice address
- 535 Main St
Suite 207
Martinez, CA 94553-1102 - Phone
- (925) 315-5277
- NPI assigned
- Jan 12, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Clinical Child & Adolescent Psychologist | 103TC2200X | |||
| Clinical Psychologist | 103TC0700X | PSY24580 | CA | Primary |
Addresses
Primary practice location
535 Main St
Suite 207
Martinez, CA 94553-1102
Mailing address
535 Main St
Suite 207
Martinez, CA 94553-1102
Phone (925) 315-5277
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 103TC0700X | Medicaid | CA | |
| 103TC0700X | Other | CA | STAFF ID |
| 5188 | Other | CA | STAFF ID # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY24580 | CA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Surf Circle Psychology Corp | Current | 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 and National Provider Directory roles.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Berkeley, CA
- NPI 1619845310
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1596499200000",
"number": "1588715155",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "535 MAIN ST",
"address_2": "SUITE 207",
"city": "MARTINEZ",
"state": "CA",
"postal_code": "945531102",
"telephone_number": "925-315-5277"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "535 MAIN ST",
"address_2": "SUITE 207",
"city": "MARTINEZ",
"state": "CA",
"postal_code": "945531102",
"telephone_number": "925-315-5277"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUNCH",
"first_name": "KEVIN",
"middle_name": "SEAN",
"name_prefix": "Dr.",
"credential": "PSY D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-12",
"last_updated": "2020-08-04",
"certification_date": "2020-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY24580",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "103TC0700X",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STAFF ID",
"identifier": "103TC0700X",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STAFF ID #",
"identifier": "5188",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Martinez, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.