NPIMap

Organization Active NPI

Northshore Psychological Associates, LLC

  • Clinical Neuropsychologist
  • Erie, PA
National Provider Identifier
1891786331
Registry record updated Feb 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
Legal business name
NORTHSHORE PSYCHOLOGICAL ASSOCIATES, LLC
Practice address
120 E 2ND St
Third Floor
Erie, PA 16507-1537
Phone
(814) 877-8013
Fax
(814) 877-8007
NPI assigned
Nov 3, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2015

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

Authorized official

Name
Dr. Michael Schwabenbauer, PHDNPI 1821093386
Title
Partner
Phone
(814) 877-8013

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical NeuropsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103G00000X Primary

Addresses

Primary practice location

120 E 2ND St
Third Floor
Erie, PA 16507-1537

Mailing address

120 E 2ND St
Third Floor
Erie, PA 16507-1537
Phone (814) 877-8013

Other identifiers 1

IdentifierTypeStateIssuer
0019240150003MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040129000783 PA Part B Supplier - Clinic/Group Practice 0244133981 Receives reassigned benefits from 14 practitioners
Practice locations: Erie, PA

National Provider Directory

National Provider Directory
Tax ID family
Northshore Psychological Assoc LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

120 E 2nd St
Fl 3
Erie, PA 16507
Phone (814) 877-4600

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1130976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423699200000",
    "number": "1891786331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 E 2ND ST",
            "address_2": "THIRD FLOOR",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165071537",
            "telephone_number": "814-877-8013",
            "fax_number": "814-877-8007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 E 2ND ST",
            "address_2": "THIRD FLOOR",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165071537",
            "telephone_number": "814-877-8013",
            "fax_number": "814-877-8007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSHORE PSYCHOLOGICAL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-03",
        "last_updated": "2015-02-12",
        "status": "A",
        "authorized_official_last_name": "SCHWABENBAUER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "814-877-8013",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0019240150003",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Erie, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.