Individual provider Active NPI

Suzanne Marie Simpson, PDH

  • Clinical Psychologist
  • La Jolla, CA
National Provider Identifier
1669491106
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY7544 Issued in CA
Practice address
5580 La Jolla Blvd Ste 82
La Jolla, CA 92037-7651
Phone
(760) 720-4997
Fax
(760) 434-3557
NPI assigned
Jul 18, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY7544 CA Primary

Addresses

Primary practice location

5580 La Jolla Blvd Ste 82
La Jolla, CA 92037-7651

Mailing address

5580 La Jolla Blvd Ste 82
La Jolla, CA 92037-7651
Phone (760) 720-4997

Other identifiers 1

IdentifierTypeStateIssuer
PV0075440MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20100809000300 CA Practitioner - Clinical Psychologist 8325171549 Practice locations: San Diego, CA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1207 Carlsbad Village Dr
Suite R
Carlsbad, CA 92008-1958

9255 Towne Centre Dr
Suite 370
San Diego, CA 92121-3036
Phone (760) 720-4997

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY7544CAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
John B. Mansdorfer, PH.D. Clinical PastSince Mar 1, 2020 Accepting new patients
Integrated Self Image Systems, Inc. PastSince Dec 12, 2007 Accepting new patients

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": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1669491106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5580 LA JOLLA BLVD STE 82",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920377651",
            "telephone_number": "760-720-4997",
            "fax_number": "760-434-3557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5580 LA JOLLA BLVD STE 82",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920377651",
            "telephone_number": "760-720-4997",
            "fax_number": "760-434-3557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMPSON",
        "first_name": "SUZANNE",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "PDH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY7544",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PV0075440",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in La Jolla, CA

Sources for this page

Verify at the official NPI Registry.