Theresa L. Ross, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY202084 Issued in ID

Practice address

777 Hospital Way
Suite G11
Pocatello, ID 83201-5175

Phone

(208) 239-1710

Fax

(208) 239-1713

NPI assigned

Jan 4, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Other, 1979

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Willamette Valley Family CenterGroup PAC ID 4082685987, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Willamette Valley Family Center

  • Clinical Psychologist
  • Oregon City, OR
  • NPI 1730309816
  Medicare reassignment Care Compare group NPD
• Pacific University

  • Optometrist
  • Hillsboro, OR
  • NPI 1306954011
  NPD

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379462400000",
    "number": "1891842563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 HOSPITAL WAY",
            "address_2": "SUITE G11",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832015175",
            "telephone_number": "208-239-1710",
            "fax_number": "208-239-1713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 HOSPITAL WAY",
            "address_2": "SUITE G11",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832015175",
            "telephone_number": "208-239-1710",
            "fax_number": "208-239-1713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSS",
        "first_name": "THERESA",
        "middle_name": "L.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-04",
        "last_updated": "2013-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "ID",
            "license": "PSY202084",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807126900",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Steven D Romriell, PTA
• Root and Rise Pediatric Therapy LLC
• Benson S Roper, CRNA
• Rose Center for Healing
• Cassidy Michelle Roske, LPC
• Roth Family Medicine and Mental Health
• Roth Family Medicine and Mental Health
• Kathryn Jill Roth, FNP-C
• Kyle A Roth, NP
• Elizabeth Lassen Rowden, MS, RDN, LD

• Clinical Psychologist in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Clinical Psychologist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2013; 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.