Individual provider Active NPI

Robert Davis Mosby, PH.D

  • Clinical Psychologist
  • Santa Rosa, CA
National Provider Identifier
1750670030
Registry record updated Apr 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY23882 Issued in CA
Practice address
1160 N Dutton Ave Ste 230
Santa Rosa, CA 95401-4658
Phone
(707) 303-3201
NPI assigned
Apr 7, 2011
Last updated
Apr 7, 2011By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 7, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY23882 CA Primary
Group Psychotherapy Psychologist 103TP2701X PSY23882 CA

Addresses

Primary practice location

1160 N Dutton Ave Ste 230
Santa Rosa, CA 95401-4658

Mailing address

611 Alta Vista Dr
Healdsburg, CA 95448-4651
Phone (707) 431-2468

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111026000751 CA Practitioner - Clinical Psychologist 5597938191 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1971
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Psych Strategies Inc a Psychological CorpGroup PAC ID 0446144497, 23 clinicians

Practice addresses (Care Compare)

1160 N Dutton Ave
Suite 230
Santa Rosa, CA 95401-4658
Phone (707) 303-3201

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY23882CAMDGroup Psychotherapy Psychologist
23882CAMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Psych Strategies Inc a Psychological Corp CurrentSince Sep 1, 2011 Accepting new patients

Locations

1160 N Dutton Ave
Ste 230
Santa Rosa, CA 95401
Phone (707) 303-3201

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1302134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1302134400000",
    "number": "1750670030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 ALTA VISTA DR",
            "city": "HEALDSBURG",
            "state": "CA",
            "postal_code": "954484651",
            "telephone_number": "707-431-2468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1160 N DUTTON AVE STE 230",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954014658",
            "telephone_number": "707-303-3201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOSBY",
        "first_name": "ROBERT",
        "middle_name": "DAVIS",
        "name_prefix": "Dr.",
        "credential": "PH.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-04-07",
        "last_updated": "2011-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY23882",
            "primary": true
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "CA",
            "license": "PSY23882",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

Verify at the official NPI Registry.