Ann Marie Donnelly, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY11715 Issued in CA

Practice address

310 James Way Ste 110
Pismo Beach, CA 93449-2877

Phone

(805) 295-0387

NPI assigned

Aug 21, 2006

Last updated

Mar 28, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

Clinical Psychologist

Education

Other, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553731200000",
    "number": "1699881938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3421",
            "city": "SHELL BEACH",
            "state": "CA",
            "postal_code": "934483421",
            "telephone_number": "805-796-9059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 JAMES WAY STE 110",
            "city": "PISMO BEACH",
            "state": "CA",
            "postal_code": "934492877",
            "telephone_number": "805-295-0387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DONNELLY",
        "first_name": "ANN MARIE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-21",
        "last_updated": "2019-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY11715",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PSY117150",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Pismo Beach, CA
• Providers in Pismo Beach, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2019; 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.

Verify at the official NPI Registry.