Individual provider Active NPI

Jessica Brianna Rosenfeld, PSYD

  • Psychologist
  • Eugene, OR
National Provider Identifier
1629476734
Registry record updated Feb 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
3134 Issued in OR
Practice address
66 Club Rd Ste 120
Eugene, OR 97401-2439
Phone
(541) 393-5983
NPI assigned
Dec 5, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Psychologist 103T00000X 3134 OR Primary

Addresses

Primary practice location

66 Club Rd Ste 120
Eugene, OR 97401-2439

Mailing address

66 Club Rd Ste 120
Eugene, OR 97401-2439
Phone (541) 393-5983

Other practice location 1

2450 S Vine St
Denver, CO 80210-5264
Phone (303) 871-4004

Other identifiers 1

IdentifierTypeStateIssuer
500768821MedicaidOR

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL www.strongibh.com Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI
Eligible to order & refer
  • Part B services: No
  • 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
I20240910002207 HI Practitioner - Clinical Psychologist 5991036139

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3134ORMDPsychologist

NPI Registry JSON

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

{
    "created_epoch": "1417737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580688000000",
    "number": "1629476734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "66 CLUB RD STE 120",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974012439",
            "telephone_number": "541-393-5983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 CLUB RD STE 120",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974012439",
            "telephone_number": "541-393-5983"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2450 S Vine St",
            "address_purpose": "LOCATION",
            "city": "Denver",
            "state": "CO",
            "postal_code": "802105264",
            "country_code": "US",
            "telephone_number": "303-871-4004",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROSENFELD",
        "first_name": "JESSICA",
        "middle_name": "BRIANNA",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-05",
        "last_updated": "2020-02-03",
        "certification_date": "2020-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OR",
            "license": "3134",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500768821",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.strongibh.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "66 Club Rd Ste 120",
            "city": "Eugene",
            "state": "OR",
            "country_code": "US",
            "postal_code": "974012439",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Eugene, OR

Sources for this page

Verify at the official NPI Registry.