Active NPI
Jeffrey Keith Bridges, PH.D.
- Clinical Psychologist
- Santa Rosa, CA
National Provider Identifier
1750431490
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY11129
- Practice address
- 576 B St
Suite 1-a
Santa Rosa, CA 95401-5269 - Phone
- (707) 546-5327
- Fax
- (707) 579-7960
- NPI assigned
- Jan 12, 2007
- 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 | PSY11129 | CA | Primary |
Addresses
Primary practice location
576 B St
Suite 1-a
Santa Rosa, CA 95401-5269
Mailing address
576 B St
Suite 1-a
Santa Rosa, CA 95401-5269
Phone (707) 546-5327
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 074148 | Other | CA | MHN PROVIDER # |
| 156248 | Other | CA | VALUEOPTIONS PROV NUM |
| OPL111290 | Other | CA | BLUE SHIELD PROV # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY11129 | CA | MD | Clinical Psychologist |
| 11129 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1185494400000",
"number": "1750431490",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "576 B ST",
"address_2": "SUITE 1-A",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954015269",
"telephone_number": "707-546-5327"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "576 B ST",
"address_2": "SUITE 1-A",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954015269",
"telephone_number": "707-546-5327",
"fax_number": "707-579-7960"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRIDGES",
"first_name": "JEFFREY",
"middle_name": "KEITH",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-12",
"last_updated": "2007-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY11129",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MHN PROVIDER #",
"identifier": "074148",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUEOPTIONS PROV NUM",
"identifier": "156248",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD PROV #",
"identifier": "OPL111290",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa, CA
- Brian Thalhamer (Wellness Chiropractic)
- Danielle E Bricker
- Emelyn M Bricker
- Guthrie Bridge, CMT
- Bridges to Self Empowerment a Marriage and Family Therapist Corporatio (Alice Petty-Hannum MFT)
- Bridges, Pregnancy Clinic and Care Center, Inc.
- Brien a Seeley M.D., Inc
- Joanna Lee Briese
- Sarah Renee Briggs
- Susan Marie Briggs, LMFT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.