Active NPI
Jessica Ford, PHD
- Clinical Psychologist
- Greenville, NC
National Provider Identifier
1689218828
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 103250
- Practice address
- 401 Moye Blvd
Greenville, NC 27834-2885 - Phone
- (252) 830-2149
- NPI assigned
- Oct 31, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cognitive & Behavioral Psychologist | 103TB0200X | 103250 | NC | |
| Health Psychologist | 103TH0004X | 103250 | NC | |
| Health Service Psychologist | 103TH0100X | 103250 | NC | |
| Clinical Psychologist | 103TC0700X | 103250 | NC | Primary |
Addresses
Primary practice location
401 Moye Blvd
Greenville, NC 27834-2885
Mailing address
401 Moye Blvd
Greenville, NC 27834-2885
Phone (252) 830-2149
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2014
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
66 E Flagler St
Miami, FL 33130-1807
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 103250 | NC | MD | Cognitive & Behavioral Psychologist |
| 5774 | NC | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grow Healthcare Group PA | Current | Accepting new patients |
Locations
3511 Shannon Rd
Fl 3
Durham, NC 27707
Phone (201) 293-7689
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": "1572480000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597363200000",
"number": "1689218828",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "401 MOYE BLVD",
"city": "GREENVILLE",
"state": "NC",
"postal_code": "278342885",
"telephone_number": "252-830-2149"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 MOYE BLVD",
"city": "GREENVILLE",
"state": "NC",
"postal_code": "278342885",
"telephone_number": "252-830-2149"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORD",
"first_name": "JESSICA",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-10-31",
"last_updated": "2020-08-14",
"certification_date": "2020-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "NC",
"license": "103250",
"primary": false
},
{
"code": "103TH0004X",
"taxonomy_group": "",
"desc": "Psychologist, Health",
"state": "NC",
"license": "103250",
"primary": false
},
{
"code": "103TH0100X",
"taxonomy_group": "",
"desc": "Psychologist, Health Service",
"state": "NC",
"license": "103250",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NC",
"license": "103250",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Greenville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2020; 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.