Individual provider Active NPI

Bettina Hodel, PH.D.

  • Clinical Psychologist
  • San Luis Obispo, CA
National Provider Identifier
1821151630
Registry record updated Sep 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY 17406 Issued in CA
Practice address
125 Serrano Heights Dr
San Luis Obispo, CA 93405-1748
Phone
(805) 286-1802
NPI assigned
Dec 19, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 5, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY 17406 CA Primary

Addresses

Primary practice location

125 Serrano Heights Dr
San Luis Obispo, CA 93405-1748

Mailing address

1446 Osprey CT
Templeton, CA 93465-9813
Phone (805) 434-9220

Other identifiers 1

IdentifierTypeStateIssuer
P00201584OtherCARAILROAD MEDICARE

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041001000727 CA Practitioner - Clinical Psychologist 1254300551 Practice locations: San Luis Obispo, CA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1234 Laurek Lane
San Luis Obispo, CA 93401
Phone (805) 543-2350

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY 17406CAMDClinical Psychologist

NPI Registry JSON

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346803200000",
    "number": "1821151630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1446 OSPREY CT",
            "city": "TEMPLETON",
            "state": "CA",
            "postal_code": "934659813",
            "telephone_number": "805-434-9220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 SERRANO HEIGHTS DR",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934051748",
            "telephone_number": "805-286-1802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HODEL",
        "first_name": "BETTINA",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-19",
        "last_updated": "2012-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY 17406",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00201584",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Luis Obispo, CA

Sources for this page

Verify at the official NPI Registry.