Individual provider Active NPI

Pamela S Prestby, PHD

  • Clinical Psychologist
  • Wauwatosa, WI
National Provider Identifier
1790805885
Registry record updated Feb 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
2250057 Issued in WI
Practice address
2600 N Mayfair Rd Ste 650
Wauwatosa, WI 53226-1322
Phone
(414) 771-9304
Fax
(414) 771-9543
NPI assigned
Mar 30, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 2250057 WI Primary

Addresses

Primary practice location

2600 N Mayfair Rd Ste 650
Wauwatosa, WI 53226-1322

Mailing address

2600 N Mayfair Rd Ste 650
Wauwatosa, WI 53226-1322
Phone (414) 771-9304

Other identifiers 1

IdentifierTypeStateIssuer
39131900MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20040304000568 WI Practitioner - Clinical Psychologist 6507753373 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Shore Counseling and Consulting Clinic SCGroup PAC ID 3072580547, 14 clinicians

Practice addresses (Care Compare)

2600 N Mayfair Rd
Suite 650
Wauwatosa, WI 53226-1321
Phone (414) 771-9304

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2250057WIMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Shore Counseling and Consulting Clinic, S.C. CurrentSince Jan 1, 2004 Accepting new patients
Midwest Comprehensive Pain Care SC PastSince Jul 1, 2002 Accepting new patients

Locations

2600 N Mayfair Rd
Ste 650
Wauwatosa, WI 53226
Phone (414) 771-9304

Organizations & group practices 2

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": "1175212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297382400000",
    "number": "1790805885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 N MAYFAIR RD STE 650",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532261322",
            "telephone_number": "414-771-9304",
            "fax_number": "414-771-9543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 N MAYFAIR RD STE 650",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532261322",
            "telephone_number": "414-771-9304",
            "fax_number": "414-771-9543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRESTBY",
        "first_name": "PAMELA",
        "middle_name": "S",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-30",
        "last_updated": "2011-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "2250057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39131900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wauwatosa, WI

Sources for this page

Verify at the official NPI Registry.