Gloria Aguilar Blanceagle, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

28250 Issued in CA

Practice address

708 Nobel Dr Unit C
Santa Cruz, CA 95060-2366

Phone

(831) 459-1818

NPI assigned

Mar 27, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Clinical Psychologist

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mendocino Coast Clinics, IncGroup PAC ID 5991619157, 19 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• Direct secure messaging: gloria.blanceagle.p1@direct.mccinc.nextgenshare.com

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.

• Mendocino Coast Clinics Inc

  • Federally Qualified Health Center (FQHC)
  • Fort Bragg, CA
  • NPI 1609595404
  Medicare reassignment Care Compare group NPD
• Mendocino Coast Clinics Inc

  • Federally Qualified Health Center (FQHC)
  • Fort Bragg, CA
  • NPI 1083783757
  NPD
• Mendocino Coast Clinics, Inc.

  • Federally Qualified Health Center (FQHC)
  • Fort Bragg, CA
  • NPI 1285128595
  NPD

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

{
    "created_epoch": "1490572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490572800000",
    "number": "1639600901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "708 NOBEL DR UNIT C",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950602366",
            "telephone_number": "831-459-1818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "708 NOBEL DR UNIT C",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950602366",
            "telephone_number": "831-459-1818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLANCEAGLE",
        "first_name": "GLORIA",
        "middle_name": "AGUILAR",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-03-27",
        "last_updated": "2017-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "28250",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Blackwell
• Krista Bladel
• Hailey Lila Blair
• Lorinda M Blake, RN
• Timothy Blakeslee, DPM
• Chamene A Blanco
• Jordi Blanco, MHRS
• Blasczyk Physical Therapy
• Judy Ann Blasczyk, RPT
• Dagny Blaskovich, LCSW

• Clinical Psychologist in Santa Cruz, CA
• Providers in Santa Cruz, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.