NPIMap

Organization Active NPI

Medical & Rehabilitation Psychology Associates, P.C.

  • Clinical Psychologist
  • Savannah, GA
National Provider Identifier
1790901742
Registry record updated Aug 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY000693 Issued in GA
Legal business name
MEDICAL & REHABILITATION PSYCHOLOGY ASSOCIATES, P.C.
Practice address
836 E 65TH St
Ste 3
Savannah, GA 31405-4411
Phone
(912) 355-5112
Fax
(912) 355-5156
NPI assigned
Apr 18, 2007
Last updated
Aug 24, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2023

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

Authorized official

Name
Michelle R. Evans, M.S.
Title
Office Manager
Phone
(912) 355-5112

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC0700X PSY000693 GA Primary
Clinical PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC0700X PSY001478 GA

Addresses

Primary practice location

836 E 65TH St
Ste 3
Savannah, GA 31405-4411

Mailing address

836 E. 65TH St.
Ste. 3
Savannah, GA 31405
Phone (912) 355-5112

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040504001108 GA Part B Supplier - Clinic/Group Practice 4688662067 Receives reassigned benefits from 3 practitioners
Practice locations: Savannah, GA

National Provider Directory

National Provider Directory

Locations

836 E 65th St
Ste 3
Savannah, GA 31405
Phone (912) 355-5112

Practitioners & affiliated clinicians

Practitioners 4

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": "1176854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692835200000",
    "number": "1790901742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "836 E. 65TH ST.",
            "address_2": "STE. 3",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "31405",
            "telephone_number": "912-355-5112",
            "fax_number": "912-355-5156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "836 E 65TH ST",
            "address_2": "STE 3",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314054411",
            "telephone_number": "912-355-5112",
            "fax_number": "912-355-5156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL & REHABILITATION PSYCHOLOGY ASSOCIATES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-18",
        "last_updated": "2023-08-24",
        "certification_date": "2023-08-24",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "912-355-5112",
        "authorized_official_credential": "M.S."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "PSY000693",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "PSY001478",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Savannah, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2023; 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.