Mark Spellmann, PHD

Primary specialty

Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X

License

3152 Issued in CT

Practice address

119 Ball Pond Rd
New Fairfield, CT 06812-4536

Phone

(203) 546-7276

NPI assigned

Apr 12, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CT, NY2 enrollments

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 2

Specialty

Clinical Psychologist

Education

Other, 1993

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": "1334188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334188800000",
    "number": "1710244017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 BALL POND RD",
            "city": "NEW FAIRFIELD",
            "state": "CT",
            "postal_code": "068124536",
            "telephone_number": "203-546-7276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 BALL POND RD",
            "city": "NEW FAIRFIELD",
            "state": "CT",
            "postal_code": "068124536",
            "telephone_number": "203-546-7276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPELLMANN",
        "first_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-04-12",
        "last_updated": "2012-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "CT",
            "license": "3152",
            "primary": true
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "NY",
            "license": "068120",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Cognitive & Behavioral Psychologist in New Fairfield, CT
• Providers in New Fairfield, CT by specialty
• Cognitive & Behavioral Psychologist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2012; 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.