Madison Health Psychology LLC

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

MADISON HEALTH PSYCHOLOGY LLC

Practice address

700 Rayovac Drive
Suite 311
Madison, WI 53711-2476

Phone

(608) 492-0053

NPI assigned

Apr 8, 2021

Last updated

Apr 8, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Gretchen A Diem, PH.D.NPI 1972521946

Title

Sole Member/Psychologist

Phone

(608) 492-0053

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gretchen A Diem, PHD

  • Psychologist
  • Madison, WI
  • NPI 1972521946
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1617840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617840000000",
    "number": "1639759343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 RAYOVAC DRIVE",
            "address_2": "SUITE 311",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537112476",
            "telephone_number": "608-492-0053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 RAYOVAC DRIVE",
            "address_2": "SUITE 311",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537112476",
            "telephone_number": "608-492-0053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADISON HEALTH PSYCHOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-08",
        "last_updated": "2021-04-08",
        "certification_date": "2021-04-08",
        "status": "A",
        "authorized_official_last_name": "DIEM",
        "authorized_official_first_name": "GRETCHEN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "SOLE MEMBER/PSYCHOLOGIST",
        "authorized_official_telephone_number": "608-492-0053",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Madison, WI
• Providers in Madison, WI by specialty
• Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.