Active NPI
Edward L Deatherage, PH.D.
- Clinical Psychologist
- Spokane, WA
National Provider Identifier
1720141575
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY00000714
- Practice address
- 5814 S Thistle LN
Spokane, WA 99223-1702 - Phone
- (208) 651-0179
- Fax
- (208) 651-0179
- NPI assigned
- Dec 19, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PY00000714 | WA | Primary |
Addresses
Primary practice location
5814 S Thistle LN
Spokane, WA 99223-1702
Mailing address
5814 S Thistle LN
Spokane, WA 99223-1702
Phone (208) 651-0179
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1977
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
Shelton, WA 98584
Phone (323) 205-7088
5814 S Thistle LN
Spokane, WA 99223-1702
Phone (509) 448-9561
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY00000714 | WA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mental Health Specialty Group PA | Current | Accepting new patients |
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": "1166486400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1466467200000",
"number": "1720141575",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5814 S THISTLE LN",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992231702",
"telephone_number": "208-651-0179",
"fax_number": "208-651-0179"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5814 S THISTLE LN",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992231702",
"telephone_number": "208-651-0179",
"fax_number": "208-651-0179"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEATHERAGE",
"first_name": "EDWARD",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-19",
"last_updated": "2016-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WA",
"license": "PY00000714",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Spokane, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2016; 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.