Individual provider Active NPI

Samira Vafadar, PSYD

  • Clinical Psychologist
  • Newport Beach, CA
National Provider Identifier
1689963514
Registry record updated Mar 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY28213 Issued in CA
Practice address
23 Corporate Plaza Dr Ste 150
Newport Beach, CA 92660-7908
Phone
(949) 329-3733
NPI assigned
Mar 31, 2011
Last updated
Mar 4, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 4, 2020

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 PSY28213 CA Primary

Addresses

Primary practice location

23 Corporate Plaza Dr Ste 150
Newport Beach, CA 92660-7908

Mailing address

23 Corporate Plaza Dr Ste 150
Newport Beach, CA 92660-7908
Phone (949) 329-3733

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
I20170216000962 CA Practitioner - Clinical Psychologist 4486937497 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Allied Psychological Services PCGroup PAC ID 1759640816, 5 clinicians

Practice addresses (Care Compare)

23 Corporate Plaza Dr
Suite 150
Newport Beach, CA 92660-7908
Phone (949) 329-3733

4740 Von Karman Ave
Suite 120
Newport Beach, CA 92660-2172
Phone (949) 910-3197

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PSY28213CAMDClinical Psychologist
28213CAMDRegistered Respiratory Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Allied Psychological Services, P.C. Clinical CurrentSince Apr 25, 2017 Accepting new patients

Locations

23 Corporate Plaza Dr
Ste 150
Newport Beach, CA 92660
Phone (949) 329-3733

4740 Von Karman Ave
Ste 120
Newport Beach, CA 92660
Phone (949) 910-3197

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, 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": "1301529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583280000000",
    "number": "1689963514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 CORPORATE PLAZA DR STE 150",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926607908",
            "telephone_number": "949-329-3733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 CORPORATE PLAZA DR STE 150",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926607908",
            "telephone_number": "949-329-3733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAFADAR",
        "first_name": "SAMIRA",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-03-31",
        "last_updated": "2020-03-04",
        "certification_date": "2020-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY28213",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newport Beach, CA

Sources for this page

Verify at the official NPI Registry.