Individual provider Active NPI

Bethyl Joy Shepperson, PSY.D.

  • Clinical Psychologist
  • Fullerton, CA
National Provider Identifier
1598813701
Registry record updated Nov 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY-1717 Issued in HI
Practice address
1619 E Chapman Ave
Fullerton, CA 92831-4015
Phone
(714) 992-4240
Fax
(714) 992-5259
NPI assigned
Jan 8, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY-1717 HI Primary

Addresses

Primary practice location

1619 E Chapman Ave
Fullerton, CA 92831-4015

Mailing address

PO Box 4938
Kailua Kona, HI 96745-4938
Phone (808) 329-7176

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200106000966 HI Practitioner - Clinical Psychologist 2062548282 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sophia Wang and Associates, Inc.Group PAC ID 2163618190, 2 clinicians

Practice addresses (Care Compare)

76-6225 Kuakini Hwy
Suite C103
Kailua Kona, HI 96740-2237
Phone (808) 936-1998

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Sophia Wang & Associates, Inc. Clinical CurrentSince Dec 1, 2019 Accepting new patients
Center for Integrative Therapy Clinical PastSince Dec 1, 2019 Accepting new patients

Locations

76-6225 Kuakini Hwy
Ste C103
Kailua Kona, HI 96740
Phone (808) 329-0943

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574812800000",
    "number": "1598813701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4938",
            "city": "KAILUA KONA",
            "state": "HI",
            "postal_code": "967454938",
            "telephone_number": "808-329-7176",
            "fax_number": "808-326-1279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1619 E CHAPMAN AVE",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928314015",
            "telephone_number": "714-992-4240",
            "fax_number": "714-992-5259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEPPERSON",
        "first_name": "BETHYL",
        "middle_name": "JOY",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-08",
        "last_updated": "2019-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "HI",
            "license": "PSY-1717",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fullerton, CA

Sources for this page

Verify at the official NPI Registry.