Individual provider Active NPI

Reece Olley Rahman

  • Psychologist
  • Indiana, PA
National Provider Identifier
1619135704
Registry record updated Oct 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PS017167 Issued in PA
Practice address
793 Old Route 119 Hwy N
Indiana, PA 15701-1372
Phone
(724) 465-5576
NPI assigned
May 27, 2008
Last updated
Oct 21, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2020

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X MI-6301012146 MI
Mental Health Counselor 101YM0800X
Psychologist 103T00000X PS017167 PA Primary
Psychologist 103T00000X

Addresses

Primary practice location

793 Old Route 119 Hwy N
Indiana, PA 15701-1372

Mailing address

793 Old Route 119 Hwy N
Indiana, PA 15701-1372
Phone (724) 465-5576

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20120314000524 PA Practitioner - Clinical Psychologist 1557520335 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
MI-6301012146MIMDCounselor
PS017167PAMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Dr. Mary Berge and Associates, LLC Past Accepting new patients
Umas Family Resource Center PastSince Aug 6, 2019 Accepting new patients

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": "1211846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603238400000",
    "number": "1619135704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "793 OLD ROUTE 119 HWY N",
            "city": "INDIANA",
            "state": "PA",
            "postal_code": "157011372",
            "telephone_number": "724-465-5576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "793 OLD ROUTE 119 HWY N",
            "city": "INDIANA",
            "state": "PA",
            "postal_code": "157011372",
            "telephone_number": "724-465-5576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAHMAN",
        "first_name": "REECE",
        "middle_name": "OLLEY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-27",
        "last_updated": "2020-10-21",
        "certification_date": "2020-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MI",
            "license": "MI-6301012146",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PS017167",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indiana, PA

Sources for this page

Verify at the official NPI Registry.