Active NPI
Jed M Sussman, PHD
- Clinical Neuropsychologist
- Pleasanton, CA
National Provider Identifier
1912965476
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- PSY7553
- Practice address
- 4466 Black Ave
Ste H
Pleasanton, CA 94566 - Phone
- (925) 600-8199
- NPI assigned
- May 3, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | PSY7553 | CA | Primary |
| Psychologist | 103T00000X | PSY7553 | CA |
Addresses
Primary practice location
4466 Black Ave
Ste H
Pleasanton, CA 94566
Mailing address
PO Box 942
Pleasanton, CA 94566
Phone (925) 600-8199
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY7553 | CA | MD | Clinical Neuropsychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146614400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1912965476",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 942",
"city": "PLEASANTON",
"state": "CA",
"postal_code": "94566",
"telephone_number": "925-600-8199"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4466 BLACK AVE",
"address_2": "STE H",
"city": "PLEASANTON",
"state": "CA",
"postal_code": "94566",
"telephone_number": "925-600-8199"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUSSMAN",
"first_name": "JED",
"middle_name": "M",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-03",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "CA",
"license": "PSY7553",
"primary": true
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY7553",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pleasanton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.