Individual provider Active NPI

Terry Michael McClanahan, PSY.D.

  • Cognitive & Behavioral Psychologist
  • San Rafael, CA
National Provider Identifier
1831250224
Registry record updated Jan 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X
License
PSY20124 Issued in CA
Practice address
820 Las Gallinas Ave
Department of Psychiatry
San Rafael, CA 94903-3410
Phone
(415) 444-3075
Fax
(415) 444-3019
NPI assigned
Dec 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cognitive & Behavioral Psychologist 103TB0200X PSY20124 CA Primary

Addresses

Primary practice location

820 Las Gallinas Ave
Department of Psychiatry
San Rafael, CA 94903-3410

Mailing address

820 Las Gallinas Ave
Department of Psychiatry
San Rafael, CA 94903-3410
Phone (415) 444-3075

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq Health Information Exchange (HIE) The Permanente Medical Group

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
I20120824000185 CA Practitioner - Clinical Psychologist 1052568144 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
University of California, San Francisco School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Permanente Medical Group IncGroup PAC ID 8921910225, 10,928 clinicians

Practice addresses (Care Compare)

710 Lawrence Express Way
Santa Clara, CA 95051-5173
Phone (408) 851-1000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PSY20124CAMDCognitive & Behavioral Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Permanente Medical Group Inc Current Accepting new patients
Permanente Medical Group, Inc CurrentSince Jul 4, 2012 Accepting new patients
Permanente Medical Group Inc CurrentSince Jul 4, 2012 Accepting new patients

Locations

1800 Harrison St
Fl 7
Oakland, CA 94612

1150 Veterans Blvd
Redwood City, CA 94063
Phone (650) 299-2015

901 Nevin Ave
Richmond, CA 94801
Phone (510) 307-1500

2200 Ofarrell St
San Francisco, CA 94115
Phone (415) 202-2000

99 Montecillo Rd
San Rafael, CA 94903
Phone (415) 444-2047

820 Las Gallinas Ave
San Rafael, CA 94903
Phone (415) 444-3522

710 Lawrence Expy
Santa Clara, CA 95051
Phone (408) 236-6400

7373 West Ln
Stockton, CA 95210
Phone (209) 476-2000

975 Sereno Dr
Vallejo, CA 94589
Phone (707) 651-1000

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641168000000",
    "number": "1831250224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 LAS GALLINAS AVE",
            "address_2": "DEPARTMENT OF PSYCHIATRY",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949033410",
            "telephone_number": "415-444-3075",
            "fax_number": "415-444-3019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 LAS GALLINAS AVE",
            "address_2": "DEPARTMENT OF PSYCHIATRY",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949033410",
            "telephone_number": "415-444-3075",
            "fax_number": "415-444-3019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCLANAHAN",
        "first_name": "TERRY",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-12",
        "last_updated": "2022-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "CA",
            "license": "PSY20124",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "99 Montecillo Rd",
            "city": "San Rafael",
            "state": "CA",
            "country_code": "US",
            "postal_code": "949033308",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in San Rafael, CA

Sources for this page

Verify at the official NPI Registry.