Soper Family Psychiatry Medical Group

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

G59380 Issued in CA

Legal business name

SOPER FAMILY PSYCHIATRY MEDICAL GROUP

Practice address

1836 Central Ave Ste a
McKinleyville, CA 95519-3667

Phone

(707) 445-4705

Fax

(707) 445-0581

NPI assigned

Jul 8, 2015

Organization subpart

No

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

Authorized official

Name

Niki Moore

Title

Office Manager

Phone

(707) 445-4705

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Anirudh Rai, MD

  • General Practice Physician
  • Valencia, CA
  • NPI 1679136865
  Medicare reassignment Care Compare group NPD
• Steve Roth, PH.D.

  • Clinical Psychologist
  • Eureka, CA
  • NPI 1417971946
  Medicare reassignment Care Compare group NPD
• Robert E Soper, M.D.

  • Psychiatry Physician
  • Eureka, CA
  • NPI 1215065362
  Medicare reassignment Care Compare group NPD
• Wendy Jean Brandon, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • McKinleyville, CA
  • NPI 1912004896
  Medicare reassignment NPD
• Gift Oluchi Okwandu, NP

  • Family Nurse Practitioner
  • Eureka, CA
  • NPI 1104434364
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1436313600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729036800000",
    "number": "1699158634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1836 CENTRAL AVE STE A",
            "city": "MCKINLEYVILLE",
            "state": "CA",
            "postal_code": "955193667",
            "telephone_number": "707-445-4705",
            "fax_number": "707-445-0581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1836 CENTRAL AVE STE A",
            "city": "MCKINLEYVILLE",
            "state": "CA",
            "postal_code": "955193667",
            "telephone_number": "707-445-4705",
            "fax_number": "707-445-0581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOPER FAMILY PSYCHIATRY MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-08",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-15",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "NIKI",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "707-445-4705"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "CA",
            "license": "G59380",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Shakal
• Zahra Shine
• Cindy Siemens, MFT
• Christa George Sinadinos
• Emily Sommerman
• Spirals of Life Wellness Center (Kari Greene C.M.T.)
• Kori Stiles
• Lucy Stokes
• Jody Swan
• Charlena Rose Tello

• Medical Specialty Clinic/Center in McKinleyville, CA
• Providers in McKinleyville, CA by specialty
• Medical Specialty Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.