Individual provider Active NPI

Carlos Xavier Montano Jr., PSY.D.

  • Clinical Psychologist
  • Newport Beach, CA
National Provider Identifier
1619055720
Registry record updated Dec 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY27861 Issued in CA
Practice address
1400 Quail St Ste 136
Newport Beach, CA 92660-2788
Phone
(949) 478-1487
NPI assigned
Nov 2, 2006
Last updated
Dec 2, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 2, 2022

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 PSY27861 CA Primary

Addresses

Primary practice location

1400 Quail St Ste 136
Newport Beach, CA 92660-2788

Mailing address

3152 Red Hill Ave Ste 260
Costa Mesa, CA 92626-3436
Phone (949) 478-1487

Other practice location 1

2386 Faraday Ave Ste 105
Carlsbad, CA 92008-7222
Phone (760) 453-7175

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20190323000080 CA Practitioner - Clinical Psychologist 6507909371 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Adr Wellness a Professional Psychology CorporationGroup PAC ID 1456764216, 10 clinicians

Practice addresses (Care Compare)

785 Grand Ave
Suite 212
Carlsbad, CA 92008-2371
Phone (760) 453-7175

Merit-based Incentive Payment System (MIPS)

Final score
98.29 of 100Reported as group
Quality
90
Improvement activities
40
Cost
74.31

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PSY27861CAMDClinical Psychologist
27861CAMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Adr Wellness a Professional Psychology Corporation CurrentSince Feb 28, 2023 Accepting new patients
Stuckey Psychological Services, PC Clinical CurrentSince Dec 4, 2018 Accepting new patients

Locations

785 Grand Ave
Ste 101
Carlsbad, CA 92008
Phone (760) 720-4964

785 Grand Ave
Ste 212
Carlsbad, CA 92008
Phone (760) 453-7175

1000 Quail St
Ste 185
Newport Beach, CA 92660
Phone (480) 243-5234

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669939200000",
    "number": "1619055720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3152 RED HILL AVE STE 260",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926263436",
            "telephone_number": "949-478-1487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 QUAIL ST STE 136",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926602788",
            "telephone_number": "949-478-1487"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2386 Faraday Ave Ste 105",
            "address_purpose": "LOCATION",
            "city": "Carlsbad",
            "state": "CA",
            "postal_code": "920087222",
            "country_code": "US",
            "telephone_number": "760-453-7175",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MONTANO",
        "first_name": "CARLOS",
        "middle_name": "XAVIER",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-02",
        "last_updated": "2022-12-02",
        "certification_date": "2022-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY27861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newport Beach, CA

Sources for this page

Verify at the official NPI Registry.