Individual provider Active NPI

Scot Liepack, PHD

  • Clinical Psychologist
  • Phoenix, AZ
National Provider Identifier
1912924853
Registry record updated Jan 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY1543 Issued in NM
Practice address
6601 W Thomas Rd
Phoenix, AZ 85033-5700
Phone
(602) 243-7277
Fax
(623) 247-9742
NPI assigned
Jul 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PSY722 HI
Clinical Psychologist 103TC0700X PSY1543 NM Primary
Psychologist 103T00000X 4061 AZ

Addresses

Primary practice location

6601 W Thomas Rd
Phoenix, AZ 85033-5700

Mailing address

PO Box 26666
Provider Enrollment
Albuquerque, NM 87125-6666
Phone (505) 923-6770

Other identifiers 1

IdentifierTypeStateIssuer
756791MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
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
I20190226002417 NM Practitioner - Clinical Psychologist 9032188057 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Presbyterian Healthcare ServicesGroup PAC ID 9234041708, 1,390 clinicians

Practice addresses (Care Compare)

4005 High Resort Blvd SE
Rio Rancho, NM 87124-5906
Phone (505) 462-6000

Hospital & facility affiliations

  • Presbyterian Hospital Hospital, Albuquerque, NM, CCN 320021

Merit-based Incentive Payment System (MIPS)

Final score
88.68 of 100Reported as group
Quality
82.35
Promoting interoperability
100
Improvement activities
40
Cost
76.6

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PSY722HIMDPsychologist
PSY1543NMMDClinical Psychologist
4061AZMDContractor

Practice roles

OrganizationSpecialtyStatusNew patients
Presbyterian Healthcare Services CurrentSince Mar 26, 2019 Accepting new patients
Presbyterian Healthcare Services CurrentSince Mar 26, 2019 Accepting new patients
Mountain Park Health Center Past Accepting new patients
Mountain Park Health Center Past Accepting new patients

Locations

2200 W 21st St
Clovis, NM 88101
Phone (505) 769-7577

4005 High Resort Blvd SE
Rio Rancho, NM 87124
Phone (505) 462-6000

Interoperability endpoints

  • Direct secure messaging: sliepack128711@direct.phs.org

Organizations & group practices 4

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548720000000",
    "number": "1912924853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26666",
            "address_2": "PROVIDER ENROLLMENT",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871256666",
            "telephone_number": "505-923-6770",
            "fax_number": "505-923-5354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6601 W THOMAS RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850335700",
            "telephone_number": "602-243-7277",
            "fax_number": "623-247-9742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIEPACK",
        "first_name": "SCOT",
        "name_prefix": "Mr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-16",
        "last_updated": "2019-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "HI",
            "license": "PSY722",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NM",
            "license": "PSY1543",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "AZ",
            "license": "4061",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "756791",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.