Active NPI
Douglas A. Daugherty, PSY.D.,HSPP
- Psychologist
- Marion, IN
National Provider Identifier
1881745453
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 20041195A
- Practice address
- 5230 S Western Ave
Marion, IN 46953-5778 - Phone
- (765) 674-2208
- Fax
- (765) 674-3273
- NPI assigned
- Jan 12, 2007
- 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 | 20041195A | IN | Primary |
Addresses
Primary practice location
5230 S Western Ave
Marion, IN 46953-5778
Mailing address
5230 S Western Ave
Marion, IN 46953-5778
Phone (765) 674-2208
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 160445000 | Other | IN | MAGELLAN |
| 200858320 | Medicaid | IN | |
| 000000249176 | Other | IN | ANTHEMBCBS |
| 7580201 | Other | IN | AETNA |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20041195A | IN | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Care Center | Psychologist | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1465948800000",
"number": "1881745453",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5230 S WESTERN AVE",
"city": "MARION",
"state": "IN",
"postal_code": "469535778",
"telephone_number": "765-674-2208",
"fax_number": "765-674-3273"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5230 S WESTERN AVE",
"city": "MARION",
"state": "IN",
"postal_code": "469535778",
"telephone_number": "765-674-2208",
"fax_number": "765-674-3273"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAUGHERTY",
"first_name": "DOUGLAS",
"middle_name": "A.",
"name_prefix": "Dr.",
"credential": "PSY.D.,HSPP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-12",
"last_updated": "2016-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "IN",
"license": "20041195A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN",
"identifier": "160445000",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200858320",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEMBCBS",
"identifier": "000000249176",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "7580201",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Marion, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.