Mark S Lytle, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY12089 Issued in CA

Practice address

11280 Tribuna Ave
San Diego, CA 92131-1929

Phone

(858) 566-4748

Fax

(858) 566-4748

NPI assigned

Dec 9, 2006

Last updated

Mar 5, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Clinical Psychologist

Education

Other, 1980

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Mark Lytle Associates a Psychology Corporation

  • Clinical Psychologist
  • San Diego, CA
  • NPI 1679875520
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1165622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1299283200000",
    "number": "1801956198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11280 TRIBUNA AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921311929",
            "telephone_number": "858-566-4748",
            "fax_number": "858-566-4748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11280 TRIBUNA AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921311929",
            "telephone_number": "858-566-4748",
            "fax_number": "858-566-4748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYTLE",
        "first_name": "MARK",
        "middle_name": "S",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-09",
        "last_updated": "2011-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY12089",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "0PL120890",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PSY120892",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jonathan Joseph Lyons, M.D
• Keith Euegene Lyons, LCSW
• Michelle Lyons, PHD
• Robert Lyons, PH.D.
• Olga Lyssanova
• Vera Lyubasyuk
• M E Halouzka DC PC
• M E Ramirez MD Inc
• M Langford OD Optometric Corporation
• Jamilah M-Nour

• Clinical Psychologist in San Diego, CA
• Providers in San Diego, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2011; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.