Individual provider Active NPI

Jessica Alyce Stembel, PSY.D., HSPP

  • Clinical Psychologist
  • Indianapolis, IN
National Provider Identifier
1659439628
Registry record updated Jun 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
20042096A Issued in IN
Practice address
8320 Madison Ave
Indianapolis, IN 46227-6066
Phone
(317) 494-0739
NPI assigned
Dec 4, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent Psychologist 103TC2200X 20042096 IN
Clinical Psychologist 103TC0700X 20042096A IN Primary

Addresses

Primary practice location

8320 Madison Ave
Indianapolis, IN 46227-6066

Mailing address

8320 Madison Ave
Indianapolis, IN 46227-6066
Phone (317) 494-0739

Other identifiers 1

IdentifierTypeStateIssuer
200845530MedicaidIN

Other names 1

  • Jessica Alyce Bissey Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20070207000521 IN Practitioner - Clinical Psychologist 7012919814 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
20042096AINMDClinical Psychologist

Interoperability endpoints

  • Direct secure messaging: jessica.bissey.p1@direct.adultandchild.nextgenshare.com

Ownership & related parties

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Adult and Child Mental Health CenterIndianapolis, IN, CCN 151010 Federally qualified health center Corporate Officer
Corporate Director
W-2 Managing Employee
Operational/Managerial Control
Sep 18, 2024
Sep 18, 2024
Sep 18, 2024
Sep 18, 2024
Adult and Child Community Medical ServicesFranklin, IN, CCN 151012 Federally qualified health center Corporate Officer
Corporate Director
W-2 Managing Employee
Operational/Managerial Control
Sep 18, 2024
Sep 18, 2024
Sep 18, 2024
Sep 18, 2024
Adult and Child HealthIndianapolis, IN, CCN 151027 Federally qualified health center Corporate Officer
Corporate Director
W-2 Managing Employee
Operational/Managerial Control
Sep 18, 2024
Sep 18, 2024
Sep 18, 2024
Sep 18, 2024
Adult and Child Health - Neighborhood ClinicIndianapolis, IN, CCN 151039 Federally qualified health center Corporate Officer
Corporate Director
W-2 Managing Employee
Operational/Managerial Control
Sep 18, 2024
Sep 18, 2024
Sep 18, 2024
Sep 18, 2024
Adult and Child -Siear TerraceIndianapolis, IN, CCN C51008 Federally qualified health center Corporate Officer
Corporate Director
W-2 Managing Employee
Operational/Managerial Control
Sep 18, 2024
Sep 18, 2024
Sep 18, 2024
Sep 18, 2024

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685577600000",
    "number": "1659439628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8320 MADISON AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462276066",
            "telephone_number": "317-494-0739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8320 MADISON AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462276066",
            "telephone_number": "317-494-0739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEMBEL",
        "first_name": "JESSICA",
        "middle_name": "ALYCE",
        "name_prefix": "Dr.",
        "credential": "PSY.D., HSPP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-04",
        "last_updated": "2023-06-01",
        "certification_date": "2023-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "IN",
            "license": "20042096",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20042096A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200845530",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "BISSEY",
            "middle_name": "ALYCE",
            "credential": "PSYD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.