Frederick Daniel Grossman, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY00897 Issued in MO

Practice address

1130 NW 12TH Ave Apt 614
Portland, OR 97209-2860

Phone

(503) 505-7227

Fax

(503) 564-0739

NPI assigned

Oct 17, 2006

Sex

Male

Sole proprietor

No

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

Enrolled in OR

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

Specialty

Clinical Psychologist

Education

University of Iowa, RJ & L Carver College of Medicine, 1977

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Integrated Psychological Services of the Pacific NorthwestGroup PAC ID 3870990476, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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.

• Integrated Psychological Services of the Pacific Northwest

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Portland, OR
  • NPI 1962071647
  Medicare reassignment Care Compare group
• Advanced Pain Management Center

  • Durable Medical Equipment & Medical Supplies
  • Portland, OR
  • NPI 1467773663
  NPD (past)
• Advanced Pain Management Center PC

  • Pain Medicine Physician
  • Portland, OR
  • NPI 1760531339
  NPD (past)

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695945600000",
    "number": "1871673509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1130 NW 12TH AVE APT 614",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972092860",
            "telephone_number": "503-505-7227",
            "fax_number": "503-564-0739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 NW 12TH AVE APT 614",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972092860",
            "telephone_number": "503-505-7227",
            "fax_number": "503-564-0739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROSSMAN",
        "first_name": "FREDERICK",
        "middle_name": "DANIEL",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2023-09-29",
        "certification_date": "2023-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MO",
            "license": "PSY00897",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brandon Russell Grosshart, DO
• Laura Grossi-Rosal
• Katy Lynn Grosskopf, LMT
• Erica Danielle Grossman, MS, LPC
• Fred M Grossman, PH.D.
• Ian Grossman
• Melissa L. Grossman, M.S., L.P.C.
• Sadie Grossman
• Brenda Lynn Grossnickle, CNS
• Douglas Reed Grossnickle, MD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.