Individual provider Active NPI

Paul Marlin Smerz, PH.D.

  • Clinical Psychologist
  • Glendale, WI
National Provider Identifier
1922168574
Registry record updated Mar 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
1242-057 Issued in WI
Practice address
6110 N Port Washington Rd
Glendale, WI 53217-4308
Phone
(414) 332-7400
Fax
(414) 963-6866
NPI assigned
Dec 12, 2006
Last updated
Mar 15, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 1242-057 WI Primary

Addresses

Primary practice location

6110 N Port Washington Rd
Glendale, WI 53217-4308

Mailing address

6110 N Port Washington Rd
Glendale, WI 53217-4308
Phone (414) 962-1000

Other identifiers 1

IdentifierTypeStateIssuer
39044000MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20080205000652 WI Practitioner - Clinical Psychologist 5890878490 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medical Psychology Associates, Inc.Group PAC ID 9133114333, 8 clinicians

Practice addresses (Care Compare)

6110 N Port Washington Rd
Glendale, WI 53217-4308
Phone (414) 962-1000

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1242-057WIMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Psychology Associates, Inc. CurrentSince Jan 15, 2008 Accepting new patients
The Cambrige Group Inc. PastSince Sep 1, 2007 Accepting new patients

Locations

6110 N Port Washington Rd
Glendale, WI 53217
Phone (414) 332-7400

6520 W Layton Ave
Ste 206
Greenfield, WI 53220
Phone (414) 962-1000

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521072000000",
    "number": "1922168574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6110 N PORT WASHINGTON RD",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532174308",
            "telephone_number": "414-962-1000",
            "fax_number": "414-963-6866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6110 N PORT WASHINGTON RD",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532174308",
            "telephone_number": "414-332-7400",
            "fax_number": "414-963-6866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMERZ",
        "first_name": "PAUL",
        "middle_name": "MARLIN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-12",
        "last_updated": "2018-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "1242-057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39044000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, WI

Sources for this page

Verify at the official NPI Registry.