Active NPI
Blue Sky Psychology Group, Inc.
- Clinical Psychologist
- Atascadero, CA
National Provider Identifier
1710782842
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- Legal business name
- BLUE SKY PSYCHOLOGY GROUP, INC.
- Practice address
- 9700 El Camino Real Ste 300
Atascadero, CA 93422-5581 - Phone
- (805) 975-5013
- NPI assigned
- Feb 13, 2025
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Jody E Debruin, PH.D.
- Title
- President
- Phone
- (805) 975-5013
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | Primary |
Addresses
Primary practice location
9700 El Camino Real Ste 300
Atascadero, CA 93422-5581
Mailing address
9700 El Camino Real Ste 300
Atascadero, CA 93422-5581
Phone (805) 975-5013
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250305001434 | CA | Part B Supplier - Clinic/Group Practice | 4284155342 |
Receives reassigned benefits from 2 practitioners Practice locations: Templeton, CA |
National Provider Directory
National Provider DirectoryLocations
9700 El Camino Real
Ste 300
Atascadero, CA 93422
Phone (805) 975-5013
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1739404800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1739404800000",
"number": "1710782842",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9700 EL CAMINO REAL STE 300",
"city": "ATASCADERO",
"state": "CA",
"postal_code": "934225581",
"telephone_number": "805-975-5013"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9700 EL CAMINO REAL STE 300",
"city": "ATASCADERO",
"state": "CA",
"postal_code": "934225581",
"telephone_number": "805-975-5013"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BLUE SKY PSYCHOLOGY GROUP, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2025-02-13",
"last_updated": "2025-02-13",
"certification_date": "2025-02-13",
"status": "A",
"authorized_official_last_name": "DEBRUIN",
"authorized_official_first_name": "JODY",
"authorized_official_middle_name": "E",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "805-975-5013",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "PH.D."
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychologist, Clinical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atascadero, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2025; 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.