Individual provider Active NPI

Elise Middleton

  • Psychologist
  • Richmond, CA
National Provider Identifier
1619377611
Registry record updated Aug 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Practice address
4101 Macdonald Ave
Richmond, CA 94805-2333
Phone
(510) 412-9200
NPI assigned
Aug 26, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2016

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
School Counselor 101YS0200X
Student in an Organized Health Care Education/Training Program 390200000X
Psychologist 103T00000X Primary

Addresses

Primary practice location

4101 Macdonald Ave
Richmond, CA 94805-2333

Mailing address

4101 Macdonald Ave
Richmond, CA 94805-2333
Phone (510) 412-9200

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
I20250109002742 CA Practitioner - Clinical Psychologist 9133657703 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

456 Montgomery St
Suite 1400
San Francisco, CA 94104-1247
Phone (855) 501-1004

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
32046CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Mark David Levine M.D. Professional Corporation Mental Health CurrentSince Jan 8, 2025 Accepting new patients
Mark David Levine, MD Burlingame PC CurrentSince Jan 8, 2025 Accepting new patients

Locations

3835 N Freeway Blvd
Ste 100
Sacramento, CA 95834
Phone (916) 576-7898

456 Montgomery St
Ste 1400
San Francisco, CA 94104
Phone (321) 241-2288

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": "1409011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471478400000",
    "number": "1619377611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4101 MACDONALD AVE",
            "city": "RICHMOND",
            "state": "CA",
            "postal_code": "948052333",
            "telephone_number": "510-412-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4101 MACDONALD AVE",
            "city": "RICHMOND",
            "state": "CA",
            "postal_code": "948052333",
            "telephone_number": "510-412-9200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIDDLETON",
        "first_name": "ELISE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-26",
        "last_updated": "2016-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YS0200X",
            "taxonomy_group": "",
            "desc": "Counselor, School",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond, CA

Sources for this page

Verify at the official NPI Registry.