Organization Active NPI

Atomic Shrink Psychology, Inc

  • Clinical Psychologist
  • Big Bear Lake, CA
National Provider Identifier
1770922817
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY20385 Issued in CA
Legal business name
ATOMIC SHRINK PSYCHOLOGY, INC
Practice address
40585 Big Bear Blvd
Suite 2
Big Bear Lake, CA 92315
Phone
(909) 255-5351
Fax
(800) 976-0803
NPI assigned
Jun 21, 2013
Last updated
Mar 17, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Authorized official

Name
Dr. Patricia Keiko Masuda-Story, PSYD.NPI 1467490987
Title
Clinical Psychologist
Phone
(818) 481-6581

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
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X PSY20385 CA Primary

Addresses

Primary practice location

40585 Big Bear Blvd
Suite 2
Big Bear Lake, CA 92315

Mailing address

17328 Ventura Blvd
Suite 134
Encino, CA 91316-3904
Phone (818) 481-6581

Other practice location 1

40415 Big Bear Blvd
Big Bear Lake, CA 92315
Phone (818) 481-6581

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180314001431 CA Part B Supplier - Clinic/Group Practice 8729364310 Receives reassigned benefits from 1 practitioner
2 other NPIs on this enrollment
Practice locations: Big Bear Lake, CA; Glendale, CA; Lancaster, CA

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Atomic Shrink Psychology Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

40585 Big Bear Blvd
Ste 2
Big Bear Lake, CA 92315
Phone (818) 481-6581

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": "1371772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1770922817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17328 VENTURA BLVD",
            "address_2": "SUITE 134",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "913163904",
            "telephone_number": "818-481-6581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40585 BIG BEAR BLVD",
            "address_2": "SUITE 2",
            "city": "BIG BEAR LAKE",
            "state": "CA",
            "postal_code": "92315",
            "telephone_number": "909-255-5351",
            "fax_number": "800-976-0803"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "40415 BIG BEAR BLVD",
            "address_purpose": "LOCATION",
            "city": "BIG BEAR LAKE",
            "state": "CA",
            "postal_code": "92315",
            "country_code": "US",
            "telephone_number": "818-481-6581",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ATOMIC SHRINK PSYCHOLOGY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-21",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "MASUDA-STORY",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "KEIKO",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "818-481-6581",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY20385",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Big Bear Lake, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.