Active NPI
Susan Pepperwood
- Clinical Psychologist
- Ukiah, CA
National Provider Identifier
1780740266
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY13479
- Practice address
- 518 S School St
# 102
Ukiah, CA 95482-5479 - Phone
- (707) 462-4369
- NPI assigned
- Dec 29, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- 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 | PSY13479 | CA | Primary |
Addresses
Primary practice location
518 S School St
# 102
Ukiah, CA 95482-5479
Mailing address
518 S School St
# 102
Ukiah, CA 95482-5479
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PSY13479 | Other | CA | CA PSYCHOLOGIST LICENSE |
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 |
|---|---|---|---|---|
| I20040506001523 | CA | Practitioner - Clinical Psychologist | 7618865981 | Practice locations: Ukiah, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1993
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
518 S School St
Suite 102
Ukiah, CA 95482-5480
Phone (707) 462-4369
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167350400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1780740266",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "518 S SCHOOL ST",
"address_2": "# 102",
"city": "UKIAH",
"state": "CA",
"postal_code": "954825479"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "518 S SCHOOL ST",
"address_2": "# 102",
"city": "UKIAH",
"state": "CA",
"postal_code": "954825479",
"telephone_number": "707-462-4369"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEPPERWOOD",
"first_name": "SUSAN",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY13479",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CA PSYCHOLOGIST LICENSE",
"identifier": "PSY13479",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ukiah, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.