Individual provider Active NPI

Robert Paul Campbell, PSY.D.

  • Psychologist
  • Philadelphia, PA
National Provider Identifier
1659048288
Registry record updated Aug 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Practice address
525 S 4TH St Ste 471
Philadelphia, PA 19147-1582
Phone
(917) 306-8465
NPI assigned
Aug 23, 2021
Last updated
Aug 23, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X NU Primary

Addresses

Primary practice location

525 S 4TH St Ste 471
Philadelphia, PA 19147-1582

Mailing address

3812 Golden Feather Way
Kissimmee, FL 34746-1918
Phone (917) 306-8465

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20230601000061 PA Practitioner - Clinical Psychologist 4082071386 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Equilibria Mental Health Services CurrentSince May 18, 2023 Accepting new patients
Equilibria Psychological and Consultation Services, LLC CurrentSince Aug 29, 2021 Accepting new patients

Locations

525 S 4th St
Ste 471
Philadelphia, PA 19147
Phone (215) 861-3685

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1629676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629676800000",
    "number": "1659048288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3812 GOLDEN FEATHER WAY",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347461918",
            "telephone_number": "917-306-8465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 S 4TH ST STE 471",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191471582",
            "telephone_number": "917-306-8465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "ROBERT",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-23",
        "last_updated": "2021-08-23",
        "certification_date": "2021-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.