Active NPI
Randall Wade Krupsaw, PH.D.
- Clinical Psychologist
- Indianapolis, IN
National Provider Identifier
1851567804
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 20040117A
- Practice address
- 8945 N Meridian St
Suite 125
Indianapolis, IN 46260-5387 - Phone
- (317) 816-5600
- Fax
- (317) 815-5975
- NPI assigned
- Apr 30, 2008
- Sex
- Male
- Sole proprietor
- Yes
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 | 20040117A | IN | Primary |
Addresses
Primary practice location
8945 N Meridian St
Suite 125
Indianapolis, IN 46260-5387
Mailing address
8945 N Meridian St
Suite 125
Indianapolis, IN 46260-5387
Phone (317) 816-5600
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20040117A | IN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209513600000",
"number": "1851567804",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8945 N MERIDIAN ST",
"address_2": "SUITE 125",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462605387",
"telephone_number": "317-816-5600",
"fax_number": "317-815-5975"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8945 N MERIDIAN ST",
"address_2": "SUITE 125",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462605387",
"telephone_number": "317-816-5600",
"fax_number": "317-815-5975"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRUPSAW",
"first_name": "RANDALL",
"middle_name": "WADE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-04-30",
"last_updated": "2008-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IN",
"license": "20040117A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.