Active NPI
Samuel Hugh Bryan, PHD
- Psychologist
- Alexandria, LA
National Provider Identifier
1881622082
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 474
- Practice address
- 5615K Jackson Street Ext
Alexandria, LA 71303-2326 - Phone
- (318) 443-7711
- Fax
- (318) 443-9804
- NPI assigned
- Jun 28, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 474 | LA | Primary |
Addresses
Primary practice location
5615K Jackson Street Ext
Alexandria, LA 71303-2326
Mailing address
5615K Jackson Street Ext
Alexandria, LA 71303-2326
Phone (318) 443-7711
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 1, 2016 through Apr 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 474 | LA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1881622082",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5615K JACKSON STREET EXT",
"city": "ALEXANDRIA",
"state": "LA",
"postal_code": "713032326",
"telephone_number": "318-443-7711"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5615K JACKSON STREET EXT",
"city": "ALEXANDRIA",
"state": "LA",
"postal_code": "713032326",
"telephone_number": "318-443-7711",
"fax_number": "318-443-9804"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRYAN",
"first_name": "SAMUEL",
"middle_name": "HUGH",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "LA",
"license": "474",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Alexandria, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.