Kelly M Bush, PSY.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

19826 Issued in CA

Practice address

710 S Broadway Ste 300
Dept of Mental Health
Walnut Creek, CA 94596-5229

Phone

(925) 295-4145

NPI assigned

Jan 12, 2007

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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

{
    "created_epoch": "1168560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642982400000",
    "number": "1649321191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 S BROADWAY STE 300",
            "address_2": "DEPT OF MENTAL HEALTH",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945965229",
            "telephone_number": "925-295-4145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 S BROADWAY STE 300",
            "address_2": "DEPT OF MENTAL HEALTH",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945965229",
            "telephone_number": "925-295-4145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSH",
        "first_name": "KELLY",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-12",
        "last_updated": "2022-01-24",
        "certification_date": "2022-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "19826",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1200 Clay Street",
            "address_2": "Suite 200 & Suite 300",
            "city": "Oakland",
            "state": "CA",
            "country_code": "US",
            "postal_code": "94612",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• David Allen Burr, DDS
• Kiera I Burrows
• Johanne Busch, PH.D.,MFC
• Susan Buseck, LCSW
• Benjamin T. Busfield, MD
• Jessica Busman
• Stuart Bussey, MD, AME
• Stacey Bustillos, ASW
• Jennifer A Butler, N.P.
• Kar-Kit Butt, RPH

• Psychologist in Walnut Creek, CA
• Providers in Walnut Creek, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.