Active NPI
Tara Sanderson, PSYD, MBA
- Clinical Psychologist
- Tigard, OR
National Provider Identifier
1841469616
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2324
- Practice address
- 11845 SW Greenburg Rd Ste 210
Tigard, OR 97223-6464 - Phone
- (971) 264-0879
- Fax
- (971) 266-4521
- NPI assigned
- Feb 26, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2324 | OR | Primary |
Addresses
Primary practice location
11845 SW Greenburg Rd Ste 210
Tigard, OR 97223-6464
Mailing address
901 Brutscher St # D141
Newberg, OR 97132-6096
Phone (971) 264-0879
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500706752 | Other | OR | DMAP |
Other names 1
- Tara Culala
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Business Administration
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dr. Sanderson and Associates, LLC | Current | Accepting new patients |
Locations
901 N Brutscher St
#D141
Newberg, OR 97132
11845 SW Greenburg Rd
Ste 210
Tigard, OR 97223
Phone (971) 264-0879
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.
-
- Psychologist
- Tigard, OR
- NPI 1124652821
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203984000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1583193600000",
"number": "1841469616",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "901 BRUTSCHER ST # D141",
"city": "NEWBERG",
"state": "OR",
"postal_code": "971326096",
"telephone_number": "971-264-0879",
"fax_number": "971-925-8613"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11845 SW GREENBURG RD STE 210",
"city": "TIGARD",
"state": "OR",
"postal_code": "972236464",
"telephone_number": "971-264-0879",
"fax_number": "971-266-4521"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANDERSON",
"first_name": "TARA",
"name_prefix": "Dr.",
"credential": "PSYD, MBA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-02-26",
"last_updated": "2020-03-03",
"certification_date": "2020-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "2324",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DMAP",
"identifier": "500706752",
"state": "OR"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "TARA",
"last_name": "CULALA",
"credential": "PSYD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Tigard, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2020; 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.