Active NPI
Jason M. Bailie, PH.D.
- Clinical Neuropsychologist
- Patton, CA
National Provider Identifier
1932494432
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- 24126
- Practice address
- 3102 E Highland Ave
Patton, CA 92369-7813 - Phone
- (909) 425-7658
- NPI assigned
- Jun 13, 2011
- Last updated
- Jun 13, 2011
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | 24126 | CA | Primary |
Addresses
Primary practice location
3102 E Highland Ave
Patton, CA 92369-7813
Mailing address
3102 E Highland Ave
Patton, CA 92369-7813
Phone (909) 425-7658
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)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24126 | CA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1307923200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1307923200000",
"number": "1932494432",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3102 E HIGHLAND AVE",
"city": "PATTON",
"state": "CA",
"postal_code": "923697813",
"telephone_number": "909-425-7658"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3102 E HIGHLAND AVE",
"city": "PATTON",
"state": "CA",
"postal_code": "923697813",
"telephone_number": "909-425-7658"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAILIE",
"first_name": "JASON",
"middle_name": "M.",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-06-13",
"last_updated": "2011-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "CA",
"license": "24126",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Patton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.