Organization Active NPI

Psychmd LLC

  • Psychiatry Physician
  • Phoenix, AZ
National Provider Identifier
1720327513
Registry record updated Oct 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
44918 Issued in AZ
Legal business name
PSYCHMD LLC
Practice address
4632 N 40TH St
Phoenix, AZ 85018-3623
Phone
(848) 248-6854
NPI assigned
Feb 14, 2013
Last updated
Oct 25, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2019

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

Authorized official

Name
Sami Victor, MDNPI 1023264587
Title
Owner/Provider
Phone
(848) 248-6854

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)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 44918 AZ Primary

Addresses

Primary practice location

4632 N 40TH St
Phoenix, AZ 85018-3623

Mailing address

4632 N 40TH St
Phoenix, AZ 85018-3623

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130518000068 AZ Part B Supplier - Clinic/Group Practice 9830336452 Receives reassigned benefits from 1 practitioner
Practice locations: Chandler, AZ; Phoenix, AZ; Gilbert, AZ

National Provider Directory

National Provider Directory

Locations

4340 E Indian School Rd
Ste 21111
Phoenix, AZ 85018
Phone (623) 516-9319

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1360800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571961600000",
    "number": "1720327513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4632 N 40TH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850183623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4632 N 40TH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850183623",
            "telephone_number": "848-248-6854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHMD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-14",
        "last_updated": "2019-10-25",
        "status": "A",
        "authorized_official_last_name": "VICTOR",
        "authorized_official_first_name": "SAMI",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "848-248-6854",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "AZ",
            "license": "44918",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2019; 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.

Verify at the official NPI Registry.