Capital City Neuropsychology, LLC

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

Legal business name

CAPITAL CITY NEUROPSYCHOLOGY, LLC

Practice address

6000 Garners Ferry Rd Ste 12
Columbia, SC 29209-1303

Phone

(803) 790-7095

NPI assigned

Feb 16, 2019

Last updated

Jan 18, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Brandon Lars Roberg, PH.D.NPI 1649798737

Title

Clinical Neuropsychologist

Phone

(803) 708-7095

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Locations

Practitioners 1

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.

• Brandon Lars Roberg, PH.D.

  • Clinical Psychologist
  • Columbia, SC
  • NPI 1649798737
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1550275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642464000000",
    "number": "1801352695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6000 GARNERS FERRY RD STE 12",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292091303",
            "telephone_number": "803-708-7095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6000 GARNERS FERRY RD STE 12",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292091303",
            "telephone_number": "803-790-7095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAPITAL CITY NEUROPSYCHOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-16",
        "last_updated": "2022-01-18",
        "certification_date": "2022-01-18",
        "status": "A",
        "authorized_official_last_name": "ROBERG",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_middle_name": "LARS",
        "authorized_official_title_or_position": "CLINICAL NEUROPSYCHOLOGIST",
        "authorized_official_telephone_number": "803-708-7095",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Neuropsychologist in Columbia, SC
• Providers in Columbia, SC by specialty
• Clinical Neuropsychologist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2022; 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.