Individual provider Active NPI

Debra Ferguson, PH.D.

  • Clinical Psychologist
  • Oakton, VA
National Provider Identifier
1679921043
Registry record updated Oct 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
0810005238 Issued in VA
Practice address
10300 Bushman Dr
#300
Oakton, VA 22124-1704
Phone
(703) 705-2922
NPI assigned
May 26, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 5, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 071005928 IL
Clinical Psychologist 103TC0700X 0810005238 VA Primary

Addresses

Primary practice location

10300 Bushman Dr
#300
Oakton, VA 22124-1704

Mailing address

2961A Hunter Mill Rd # 642
Oakton, VA 22124-1704
Phone (312) 543-5107

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
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
I20161115001519 DC Practitioner - Clinical Psychologist 4880973874 Reassigns benefits to 1 organization

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)

10300 Bushman Dr
Apt 309
Oakton, VA 22124-2826
Phone (703) 705-2922

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
071005928ILMDClinical Psychologist
0810005238VAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
4 Roses Psychological Services. PLLC CurrentSince Nov 1, 2022 Accepting new patients

Locations

2961A Hunter Mill Rd
Oakton, VA 22124
Phone (703) 914-3237

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": "1464220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664928000000",
    "number": "1679921043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2961A HUNTER MILL RD # 642",
            "city": "OAKTON",
            "state": "VA",
            "postal_code": "221241704",
            "telephone_number": "312-543-5107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10300 BUSHMAN DR",
            "address_2": "#300",
            "city": "OAKTON",
            "state": "VA",
            "postal_code": "221241704",
            "telephone_number": "703-705-2922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERGUSON",
        "first_name": "DEBRA",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-05-26",
        "last_updated": "2022-10-05",
        "certification_date": "2022-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071005928",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810005238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakton, VA

Sources for this page

Verify at the official NPI Registry.