NPIMap

Organization Active NPI

Children's Hospital of Orange County

  • Clinical Child & Adolescent Psychologist
  • Orange, CA
National Provider Identifier
1659918852
Registry record updated Dec 6, 2019
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Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
Legal business name
CHILDREN'S HOSPITAL OF ORANGE COUNTY
Practice address
170 S Main St
Orange, CA 92868-2801
Phone
(714) 288-7651
Fax
(714) 288-7379
NPI assigned
Dec 6, 2019
Organization subpart
Yes
Parent organization
CHILDREN'S HOSPITAL OF ORANGE COUNTYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 6, 2019

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

Authorized official

Name
Mark Kelly
Title
Director, Revenue Cycle Support
Phone
(714) 509-7861

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X
Cognitive & Behavioral PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TB0200X
Clinical Child & Adolescent PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC2200X Primary
Assistant Behavior AnalystGroup: 193200000X MULTI-SPECIALTY GROUP 106E00000X
Neurology with Special Qualifications in Child Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0402X
Child & Adolescent Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0804X

Addresses

Primary practice location

170 S Main St
Orange, CA 92868-2801

Mailing address

1201 W la Veta Ave
Orange, CA 92868-4203

Other identifiers 1

IdentifierTypeStateIssuer
1093102766MedicaidCA

Other names 1

  • The Thompson Autism Center at CHOC Children's Other name

National Provider Directory

National Provider Directory
Tax ID family
Regional Ctr for the55 organizations share this tax ID, including this one
Part of
Regional Ctr for the

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1575590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1575590400000",
    "number": "1659918852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 W LA VETA AVE",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928684203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 S MAIN ST",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928682801",
            "telephone_number": "714-288-7651",
            "fax_number": "714-288-7379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S HOSPITAL OF ORANGE COUNTY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHILDREN'S HOSPITAL OF ORANGE COUNTY",
        "enumeration_date": "2019-12-06",
        "last_updated": "2019-12-06",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "DIRECTOR, REVENUE CYCLE SUPPORT",
        "authorized_official_telephone_number": "714-509-7861"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Assistant Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0402X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1093102766",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Thompson Autism Center at CHOC Children's",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Orange, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.