Individual provider Active NPI

James McBride Ottesen, PH.D.

  • Clinical Psychologist
  • St George, UT
National Provider Identifier
1831102490
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
96-325458-2501 Issued in UT
Practice address
640 E 700 S
Suite 207
St George, UT 84770-4023
Phone
(435) 652-0322
Fax
(435) 652-0350
NPI assigned
Aug 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 96-325458-2501 UT Primary

Addresses

Primary practice location

640 E 700 S
Suite 207
St George, UT 84770-4023

Mailing address

640 E 700 S
Suite 207
St George, UT 84770-4023
Phone (435) 652-0322

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
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
I20061201000325 UT Practitioner - Clinical Psychologist 8729086681 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

640 E 700
Suite 207
St George, UT 84770-5732
Phone (435) 652-0322

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
96-325458-2501UTMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
James M Ottesen PHD Inc Clinical CurrentSince Mar 3, 1997 Accepting new patients

Locations

640 E 700 S
Ste 207
St George, UT 84770
Phone (435) 628-2718

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1831102490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 E 700 S",
            "address_2": "SUITE 207",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847704023",
            "telephone_number": "435-652-0322",
            "fax_number": "435-652-0350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 E 700 S",
            "address_2": "SUITE 207",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847704023",
            "telephone_number": "435-652-0322",
            "fax_number": "435-652-0350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTTESEN",
        "first_name": "JAMES",
        "middle_name": "MCBRIDE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "UT",
            "license": "96-325458-2501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St George, UT

Sources for this page

Verify at the official NPI Registry.