Robert Edward Sack III, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY23839 Issued in CA

Practice address

3100 Wright Rd.
Camarillo, CA 93010

Phone

(559) 448-7764

NPI assigned

Oct 15, 2010

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Credentials

Doctor of Philosophy

Practice roles

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.

• Elevate Psychological Group Inc

  • Psychologist
  • Camarillo, CA
  • NPI 1194317750
  NPD Authorized official

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

{
    "created_epoch": "1287100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287100800000",
    "number": "1851601454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 WRIGHT RD.",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "93010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 WRIGHT RD.",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "93010",
            "telephone_number": "559-448-7764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SACK",
        "first_name": "ROBERT",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-10-15",
        "last_updated": "2010-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY23839",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy Chistopher Ryan, L.AC.
• Hannah Marie Ryland
• S-H Opco Camarillo, LLC
• S-H Opco Camarillo, LLC
• Noa Sabag, COTA
• Lauren Ciara Saenz
• Devanie Saeteurn
• Ulysses Raguindin Sagun, PT
• Kiran K. Sahota, M.A.
• Sukhanchal G Saini, DDS

• Psychologist in Camarillo, CA
• Providers in Camarillo, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2010; 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.