Active NPI
Jeremy Madoff, PH.D.
- Clinical Psychologist
- San Diego, CA
National Provider Identifier
1740204569
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY 7502
- Practice address
- 3914 Murphy Canyon Rd
Suite A241
San Diego, CA 92123-4491 - Phone
- (858) 569-0454
- NPI assigned
- Jul 26, 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 | PSY 7502 | CA | Primary |
Addresses
Primary practice location
3914 Murphy Canyon Rd
Suite A241
San Diego, CA 92123-4491
Mailing address
3914 Murphy Canyon Rd
Suite A241
San Diego, CA 92123-4491
Phone (858) 569-0454
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101013000282 | CA | Practitioner - Clinical Psychologist | 8022200765 | Practice locations: San Diego, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1980
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
3914 Murphy Canyon Rd
Suite A205
San Diego, CA 92123-4423
Phone (858) 569-0454
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 7502 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1418256000000",
"number": "1740204569",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3914 MURPHY CANYON RD",
"address_2": "SUITE A241",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921234491",
"telephone_number": "858-569-0454"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3914 MURPHY CANYON RD",
"address_2": "SUITE A241",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921234491",
"telephone_number": "858-569-0454"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MADOFF",
"first_name": "JEREMY",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-26",
"last_updated": "2014-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY 7502",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2014; 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.