Active NPI
Jonathan Shaffer, PH.D.
- Clinical Psychologist
- Arvada, CO
National Provider Identifier
1801170220
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 019151
- Practice address
- 6121 W 60TH Ave
Arvada, CO 80003-5603 - Phone
- (303) 420-4550
- NPI assigned
- Oct 4, 2011
- Last updated
- Aug 1, 2016
- Sex
- Male
- 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 | 019151 | NY | Primary |
Addresses
Primary practice location
6121 W 60TH Ave
Arvada, CO 80003-5603
Mailing address
4860 Robb St
Suite 201
Wheat Ridge, CO 80033-2184
Phone (303) 278-7418
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 13862744 | Other | CO | CAQH |
| PSY.0004404 | Other | CO | PROFESSIONAL LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019151 | NY | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sondermind Provider Network LLC | Clinical | Current | Accepting new patients |
Locations
720 S Colorado Blvd
Ph N
Glendale, CO 80246
Phone (833) 988-0589
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Clinical Social Worker
- Denver, CO
- NPI 1760854442
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1470009600000",
"number": "1801170220",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4860 ROBB ST",
"address_2": "SUITE 201",
"city": "WHEAT RIDGE",
"state": "CO",
"postal_code": "800332184",
"telephone_number": "303-278-7418",
"fax_number": "303-223-9315"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6121 W 60TH AVE",
"city": "ARVADA",
"state": "CO",
"postal_code": "800035603",
"telephone_number": "303-420-4550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAFFER",
"first_name": "JONATHAN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-10-04",
"last_updated": "2016-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "019151",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "13862744",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PROFESSIONAL LICENSE",
"identifier": "PSY.0004404",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Arvada, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2016; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.