Active NPI
Kathleen F Nyborg, PH.D.
- Psychologist
- Ellsworth, ME
National Provider Identifier
1659413680
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PS585
- Practice address
- 210 Main St
Ellsworth, ME 04605 - Phone
- (207) 667-3795
- NPI assigned
- Feb 13, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PS585 | ME | Primary |
Addresses
Primary practice location
210 Main St
Ellsworth, ME 04605
Mailing address
PO Box 151
Sullivan, ME 04664
Phone (207) 667-3795
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 223660000 | Medicaid | ME | |
| X0298 | Other | ME | ANTHEM BC BS |
Other names 1
- Kathy F. Nyborg
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ME
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050613000394 | ME | Practitioner - Clinical Psychologist | 3577507409 | Practice locations: Ellsworth, ME; Sullivan, ME |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1985
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
21 Plover LN
Sullivan, ME 04664-3002
Phone (207) 667-3795
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS585 | ME | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171324800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1426032000000",
"number": "1659413680",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 151",
"city": "SULLIVAN",
"state": "ME",
"postal_code": "04664",
"telephone_number": "207-667-3795"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 MAIN ST",
"city": "ELLSWORTH",
"state": "ME",
"postal_code": "04605",
"telephone_number": "207-667-3795"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NYBORG",
"first_name": "KATHLEEN",
"middle_name": "F",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-13",
"last_updated": "2015-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "ME",
"license": "PS585",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "223660000",
"state": "ME"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BC BS",
"identifier": "X0298",
"state": "ME"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KATHY",
"last_name": "NYBORG",
"middle_name": "F.",
"credential": "PH.D.",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Ellsworth, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2015; 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.