Ezekiel N Sanders, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

3132 Issued in OR

Practice address

384 SE Combs Flat Rd Ste 1200
Prineville, OR 97754-2562

Phone

(541) 447-6263

Fax

(541) 447-8724

NPI assigned

Nov 15, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: esanders511340@oc.providencedirect.org

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

{
    "created_epoch": "1352937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707350400000",
    "number": "1831433812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "384 SE COMBS FLAT RD",
            "city": "PRINEVILLE",
            "state": "OR",
            "postal_code": "977542562",
            "telephone_number": "541-447-6263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "384 SE COMBS FLAT RD STE 1200",
            "city": "PRINEVILLE",
            "state": "OR",
            "postal_code": "977542562",
            "telephone_number": "541-447-6263",
            "fax_number": "541-447-8724"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1230 NE 3rd St # A160-E",
            "address_purpose": "LOCATION",
            "city": "Bend",
            "state": "OR",
            "postal_code": "977014367",
            "country_code": "US",
            "telephone_number": "541-203-2407",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANDERS",
        "first_name": "EZEKIEL",
        "middle_name": "N",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-11-15",
        "last_updated": "2024-02-08",
        "certification_date": "2024-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "3132",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "esanders511340@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "9290 SE Sunnybrook Blvd Ste 120",
            "city": "Clackamas",
            "state": "OR",
            "country_code": "US",
            "postal_code": "970156802",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Samantha Russo, CRM
• Jamie Ryan
• Vicky Jeanne Ryan
• Jeff Bryan Salisbury
• Charles Keith Sanborn
• Kathie Dianne Sanders, PEER SUPPORT
• Amanda Lynn Sandoval
• Geoffrey Michael Saunders, PHARMD
• Charissa Schmidt
• Adriaa L Schmitt, LMT

• Clinical Psychologist in Prineville, OR
• Providers in Prineville, OR by specialty
• Clinical Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.