Active NPI
Dana Marie Fillmore, PSY.D.
- Clinical Psychologist
- San Diego, CA
National Provider Identifier
1891912887
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY16714
- Practice address
- 12625 High Bluff Dr
Suite 104
San Diego, CA 92130-2052 - Phone
- (858) 755-7844
- NPI assigned
- Apr 19, 2007
- Sex
- Female
- 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 | PSY16714 | CA | Primary |
Addresses
Primary practice location
12625 High Bluff Dr
Suite 104
San Diego, CA 92130-2052
Mailing address
12625 High Bluff Dr
Suite 104
San Diego, CA 92130-2052
Phone (858) 755-7844
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 1, 2022 through Jul 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY16714 | CA | MD | Clinical Psychologist |
| 16714 | CA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1239148800000",
"number": "1891912887",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12625 HIGH BLUFF DR",
"address_2": "SUITE 104",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921302052",
"telephone_number": "858-755-7844"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12625 HIGH BLUFF DR",
"address_2": "SUITE 104",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921302052",
"telephone_number": "858-755-7844"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FILLMORE",
"first_name": "DANA",
"middle_name": "MARIE",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-19",
"last_updated": "2009-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY16714",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2009; 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.