Individual provider Active NPI

Nadya Friedman

  • Psychiatry Physician
  • Clearlake, CA
National Provider Identifier
1811048911
Registry record updated Feb 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
C155143 Issued in CA
Practice address
15230 Lakeshore Dr
Clearlake, CA 95422-8107
Phone
(707) 995-4500
NPI assigned
Jan 15, 2007
Last updated
Feb 14, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 241466 NY
Psychiatry Physician 2084P0800X C155143 CA Primary

Addresses

Primary practice location

15230 Lakeshore Dr
Clearlake, CA 95422-8107

Mailing address

15230 Lakeshore Dr
Clearlake, CA 95422-8107
Phone (707) 995-4500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180629001301 CA Practitioner - Psychiatry 2163508896 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
East Tennessee State University Quillen College of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

15630 18TH Ave
Clearlake, CA 95422-9336
Phone (707) 994-6486

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
241466NYMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Adventist Health Clearlake Hospital Inc. CurrentSince Feb 1, 2022 Accepting new patients
Community Hospital of the Monterey Peninsula CurrentSince Jun 12, 2018 Accepting new patients
Community Hospital of the Monterey Peninsula CurrentSince Jun 12, 2018 Accepting new patients

Locations

15230 Lakeshore Dr
Clearlake, CA 95422
Phone (707) 995-4500

15630 18th Ave
Clearlake, CA 95422
Phone (707) 995-5820

23625 Wr Holman Hwy
Monterey, CA 93940
Phone (831) 622-2708

576 Hartnell St
Monterey, CA 93940
Phone (831) 625-4600

576 Hartnell St
Ste 300
Monterey, CA 93940
Phone (831) 625-4600

Organizations & group practices 3

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1168819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644796800000",
    "number": "1811048911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15230 LAKESHORE DR",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "954228107",
            "telephone_number": "707-995-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15230 LAKESHORE DR",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "954228107",
            "telephone_number": "707-995-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRIEDMAN",
        "first_name": "NADYA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-15",
        "last_updated": "2022-02-14",
        "certification_date": "2022-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "241466",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "C155143",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clearlake, CA

Sources for this page

Verify at the official NPI Registry.