Wesley Pederson, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY26040 Issued in CA

Practice address

617 Veterans Blvd
Suite 204
Redwood City, CA 94063-1496

Phone

(650) 804-8739

NPI assigned

Nov 4, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2017 through Jan 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• The Wise Mind Institute, a Psychological Corporation

  • Psychologist
  • Redwood City, CA
  • NPI 1174990360
  NPD Authorized official

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

{
    "created_epoch": "1383523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407715200000",
    "number": "1598194227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "617 VETERANS BLVD",
            "address_2": "SUITE 204",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "940631496",
            "telephone_number": "650-804-8739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "617 VETERANS BLVD",
            "address_2": "SUITE 204",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "940631496",
            "telephone_number": "650-804-8739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSON",
        "first_name": "WESLEY",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-11-04",
        "last_updated": "2014-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY26040",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah N Payne
• Peak Performance Physical Therapy
• Scott Jason Peak, MD
• Rachel Pearce, OT
• Christine A Pearston, PSYD
• Pediatric Wellness Group
• Pedro'S Marriage & Family Counseling Inc.
• Gloria Pedruco, NP
• Martha Pelayo
• Marie Pelner, PT, DPT

• Psychologist in Redwood City, CA
• Providers in Redwood City, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2014; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.