Active NPI
Lisa Anne Schimmel, PH.D.
- Clinical Psychologist
- Portland, OR
National Provider Identifier
1801908413
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1709
- Practice address
- 1130 SW Morrison St
Suite 619
Portland, OR 97205-2234 - Phone
- (503) 381-9524
- Fax
- (855) 714-4323
- NPI assigned
- Aug 31, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY 15072 | CA | |
| Clinical Psychologist | 103TC0700X | 1709 | OR | Primary |
Addresses
Primary practice location
1130 SW Morrison St
Suite 619
Portland, OR 97205-2234
Mailing address
1631 NE Broadway St
PMB 738
Portland, OR 97232-1425
Phone (503) 381-9524
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| OPL150720 | Other | CA | BLUESHIELD OF CALIFORNIA |
| 178132 | Other | CA | MHN |
| PSY 15072 | Other | CA | MEDI-CAL PROVIDER NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 15072 | CA | MD | Clinical Psychologist |
| 1709 | OR | MD | Naturopath |
Interoperability endpoints
- lschimmelphd75113@direct.ohsu.edu
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340582400000",
"number": "1801908413",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1631 NE BROADWAY ST",
"address_2": "PMB 738",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972321425",
"telephone_number": "503-381-9524",
"fax_number": "855-714-4323"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1130 SW MORRISON ST",
"address_2": "SUITE 619",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972052234",
"telephone_number": "503-381-9524",
"fax_number": "855-714-4323"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SCHIMMEL",
"first_name": "LISA",
"middle_name": "ANNE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-31",
"last_updated": "2012-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY 15072",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "1709",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUESHIELD OF CALIFORNIA",
"identifier": "OPL150720",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MHN",
"identifier": "178132",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDI-CAL PROVIDER NUMBER",
"identifier": "PSY 15072",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.