Individual provider Active NPI

Kelsey Smith

  • Psychologist
  • Anaheim, CA
National Provider Identifier
1790336857
Registry record updated Aug 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Practice address
505 N Euclid St Ste 300
Anaheim, CA 92801-5514
Phone
(714) 871-5646
NPI assigned
Sep 20, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X CA Primary

Addresses

Primary practice location

505 N Euclid St Ste 300
Anaheim, CA 92801-5514

Mailing address

505 N Euclid St Ste 300
Anaheim, CA 92801-5514
Phone (714) 871-5646

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
I20240820002707 CA Practitioner - Clinical Psychologist 8628516770 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orange County Health Psychologists IncGroup PAC ID 4688990260, 59 clinicians

Practice addresses (Care Compare)

15635 Alton Pkwy
Suite 350
Irvine, CA 92618-7333
Phone (949) 528-6300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Kamala Thomas Psychological Services Corp CurrentSince Aug 6, 2024 Accepting new patients
Orange County Health Psychologists, Inc. CurrentSince Aug 6, 2024 Accepting new patients
Western Youth Services PastSince Sep 4, 2022 Accepting new patients

Locations

15635 Alton Pkwy
Ste 350
Irvine, CA 92618
Phone (949) 528-6300

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": "1568937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661817600000",
    "number": "1790336857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 N EUCLID ST STE 300",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928015514",
            "telephone_number": "714-871-5646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 N EUCLID ST STE 300",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928015514",
            "telephone_number": "714-871-5646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KELSEY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-20",
        "last_updated": "2022-08-30",
        "certification_date": "2022-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Anaheim, CA

Sources for this page

Verify at the official NPI Registry.