Individual provider Active NPI

Caleb Goodman Nixon, PSYD

  • Clinical Psychologist
  • Seattle, WA
National Provider Identifier
1740743319
Registry record updated Jan 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY61131091 Issued in WA
Practice address
800 5TH Ave Ste P100
Seattle, WA 98104-3176
Phone
(206) 320-3351
Fax
(206) 554-7787
NPI assigned
Apr 10, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PY61131091 WA
Clinical Psychologist 103TC0700X PY61131091 WA Primary

Addresses

Primary practice location

800 5TH Ave Ste P100
Seattle, WA 98104-3176

Mailing address

PO Box 25608
Salt Lake City, UT 84125-0608
Phone (206) 320-4476

Other identifiers 1

IdentifierTypeStateIssuer
1740743319MedicaidWA

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211028000627 WA Practitioner - Clinical Psychologist 3870981699 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Swedish Health ServicesGroup PAC ID 9537072814, 384 clinicians

Practice addresses (Care Compare)

800 5TH Ave
Suite P100
Seattle, WA 98104-3176
Phone (206) 320-3351

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PY61131091WAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Swedish Health Services CurrentSince Oct 4, 2021 Accepting new patients
Swedish Health Services CurrentSince Oct 4, 2021 Accepting new patients
Youth Eastside Services Past Accepting new patients

Locations

13020 Meridian Ave S
Everett, WA 98208
Phone (425) 357-3700

800 5th Ave
Ste P100
Seattle, WA 98104
Phone (206) 320-2700

800 5th Ave
Ste 600
Seattle, WA 98104

2450 33rd Ave W
Ste 100
Seattle, WA 98199
Phone (206) 320-3364

Interoperability endpoints

  • Direct secure messaging: caleb.nixon.p3@direct.hpc.nextgenshare.com

Organizations & group practices 3

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": "1554854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642464000000",
    "number": "1740743319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 25608",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841250608",
            "telephone_number": "206-320-4476",
            "fax_number": "206-568-7043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 5TH AVE STE P100",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981043176",
            "telephone_number": "206-320-3351",
            "fax_number": "206-554-7787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIXON",
        "first_name": "CALEB",
        "middle_name": "GOODMAN",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-10",
        "last_updated": "2022-01-18",
        "certification_date": "2022-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WA",
            "license": "PY61131091",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "PY61131091",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1740743319",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.