Individual provider Active NPI

Mark F Fry, PHD, LP

  • Clinical Psychologist
  • Walnut Creek, CA
National Provider Identifier
1699705053
Registry record updated Sep 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
19332 Issued in CA
Practice address
2970 Camino Diablo Ste 300
Walnut Creek, CA 94597-4001
Phone
(925) 282-1778
Fax
(415) 296-5299
NPI assigned
Jul 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2026

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 19332 CA Primary

Addresses

Primary practice location

2970 Camino Diablo Ste 300
Walnut Creek, CA 94597-4001

Mailing address

2970 Camino Diablo Ste 300
Walnut Creek, CA 94597-4001
Phone (925) 282-1778

Other practice location 1

1226 Rossmoor Pkwy
Walnut Creek, CA 94595-2538
Phone (925) 975-5000

Other identifiers 1

IdentifierTypeStateIssuer
PSY 193320MedicaidCA

Other names 1

  • Mark Fry Former name

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
I20040131000302 CA Practitioner - Clinical Psychologist 1658274097 Reassigns benefits to 1 organization
Practice locations: Walnut Creek, CA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Pacific Coast Psychiatric Associates IncGroup PAC ID 2567469174, 637 clinicians

Practice addresses (Care Compare)

2970 Camino Diablo
Suite 300
Walnut Creek, CA 94597-4001
Phone (925) 282-1778

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
19332CAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pacific Coast Psychiatric Associates Inc Clinical CurrentSince Jul 1, 2024 Accepting new patients

Locations

1480 64th St
Ste 150
Emeryville, CA 94608
Phone (415) 296-5292

2970 Camino Diablo
Ste 300
Walnut Creek, CA 94597
Phone (925) 231-4225

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": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788998400000",
    "number": "1699705053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2970 CAMINO DIABLO STE 300",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945974001",
            "telephone_number": "925-282-1778",
            "fax_number": "415-296-5299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2970 CAMINO DIABLO STE 300",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945974001",
            "telephone_number": "925-282-1778",
            "fax_number": "415-296-5299"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1226 ROSSMOOR PKWY",
            "address_purpose": "LOCATION",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945952538",
            "country_code": "US",
            "telephone_number": "925-975-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FRY",
        "first_name": "MARK",
        "middle_name": "F",
        "name_prefix": "Dr.",
        "credential": "PHD, LP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-03",
        "last_updated": "2026-09-10",
        "certification_date": "2026-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "19332",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PSY 193320",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARK",
            "last_name": "FRY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Walnut Creek, CA

Sources for this page

Verify at the official NPI Registry.