Individual provider Active NPI

Faust Bianco Jr., PH.D.

  • Health Service Psychologist
  • Tulsa, OK
National Provider Identifier
1912043860
Registry record updated Jul 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service PsychologistTaxonomy code 103TH0100X
License
754 Issued in OK
Practice address
7146 S Braden Ave
Ste. 500
Tulsa, OK 74136-6371
Phone
(918) 488-6165
Fax
(918) 488-8021
NPI assigned
Jan 29, 2007
Last updated
Jul 15, 2010By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 15, 2010

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X 754 OK
Clinical Neuropsychologist 103G00000X 579 HI
Clinical Psychologist 103TC0700X 754 OK
Clinical Psychologist 103TC0700X 579 HI
Health Service Psychologist 103TH0100X 754 OK Primary
Health Service Psychologist 103TH0100X 579 HI

Addresses

Primary practice location

7146 S Braden Ave
Ste. 500
Tulsa, OK 74136-6371

Mailing address

1761 E 31St St
Tulsa, OK 74105-2201
Phone (918) 746-0794

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20120124000137 OK Practitioner - Clinical Psychologist 9234306754 Practice locations: Tulsa, OK

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

7146 S Braden Ave
Suite 500
Tulsa, OK 74136-6376
Phone (918) 488-6165

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
579HIMDMental Health Counselor
754OKMDPhysician Assistant

NPI Registry JSON

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1279152000000",
    "number": "1912043860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1761 E 31ST ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741052201",
            "telephone_number": "918-746-0794",
            "fax_number": "918-746-0717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7146 S BRADEN AVE",
            "address_2": "STE. 500",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741366371",
            "telephone_number": "918-488-6165",
            "fax_number": "918-488-8021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BIANCO",
        "first_name": "FAUST",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-29",
        "last_updated": "2010-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "OK",
            "license": "754",
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "HI",
            "license": "579",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OK",
            "license": "754",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "HI",
            "license": "579",
            "primary": false
        },
        {
            "code": "103TH0100X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health Service",
            "state": "OK",
            "license": "754",
            "primary": true
        },
        {
            "code": "103TH0100X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health Service",
            "state": "HI",
            "license": "579",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.