Active NPI
Craig Allan Siders, PH.D.
- Clinical Neuropsychologist
- Sherman Oaks, CA
National Provider Identifier
1669709275
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- PSY25702
- Practice address
- 15300 Ventura Blvd
Suite 324
Sherman Oaks, CA 91403-3103 - Phone
- (818) 971-9392
- NPI assigned
- Nov 3, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | PSY25702 | CA | Primary |
| Psychologist | 103T00000X | 25702 | CA |
Addresses
Primary practice location
15300 Ventura Blvd
Suite 324
Sherman Oaks, CA 91403-3103
Mailing address
15300 Ventura Blvd
Suite 324
Sherman Oaks, CA 91403-3103
Phone (818) 971-9392
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150728005999 | CA | Practitioner - Clinical Psychologist | 3577877000 | Practice locations: Sherman Oaks, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
15300 Ventura Blvd
Suite 326
Sherman Oaks, CA 91403-3148
Phone (818) 971-9392
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY25702 | CA | MD | Clinical Neuropsychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1257206400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1467417600000",
"number": "1669709275",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15300 VENTURA BLVD",
"address_2": "SUITE 324",
"city": "SHERMAN OAKS",
"state": "CA",
"postal_code": "914033103",
"telephone_number": "818-971-9392"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15300 VENTURA BLVD",
"address_2": "SUITE 324",
"city": "SHERMAN OAKS",
"state": "CA",
"postal_code": "914033103",
"telephone_number": "818-971-9392"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIDERS",
"first_name": "CRAIG",
"middle_name": "ALLAN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-11-03",
"last_updated": "2016-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "CA",
"license": "PSY25702",
"primary": true
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "25702",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sherman Oaks, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2016; 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.