Active NPI
Michael Fenton, PHD
- Clinical Psychologist
- Newport Beach, CA
National Provider Identifier
1881654846
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY9254
- Practice address
- 1000 Quail St
Suite 170
Newport Beach, CA 92660-2839 - Phone
- (949) 833-7933
- Fax
- (949) 833-3963
- NPI assigned
- Mar 24, 2006
- 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 | PSY9254 | CA | Primary |
Addresses
Primary practice location
1000 Quail St
Suite 170
Newport Beach, CA 92660-2839
Mailing address
1000 Quail St
Suite 170
Newport Beach, CA 92660-2731
Phone (949) 833-7933
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PSY092540 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080722000128 | CA | Practitioner - Clinical Psychologist | 1052484243 | Practice locations: Irvine, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1986
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
4255 Campus Dr
Irvine, CA 92616-9998
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY9254 | CA | MD | Clinical Psychologist |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1221091200000",
"number": "1881654846",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 QUAIL ST",
"address_2": "SUITE 170",
"city": "NEWPORT BEACH",
"state": "CA",
"postal_code": "926602731",
"telephone_number": "949-833-7933",
"fax_number": "949-833-3963"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 QUAIL ST",
"address_2": "SUITE 170",
"city": "NEWPORT BEACH",
"state": "CA",
"postal_code": "926602839",
"telephone_number": "949-833-7933",
"fax_number": "949-833-3963"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FENTON",
"first_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-03-24",
"last_updated": "2008-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY9254",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PSY092540",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Newport Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2008; 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.