Individual provider Active NPI

John C Skrovan, PH.D.

  • Clinical Psychologist
  • Ithaca, NY
National Provider Identifier
1972720894
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
014942 Issued in NY
Practice address
215 N Cayuga St
Suite 209
Ithaca, NY 14850-4329
Phone
(607) 273-5522
NPI assigned
Apr 20, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 014942 NY Primary

Addresses

Primary practice location

215 N Cayuga St
Suite 209
Ithaca, NY 14850-4329

Mailing address

215 N Cayuga St
Suite 209
Ithaca, NY 14850-4329
Phone (607) 273-5522

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20200311001297 NY Practitioner - Clinical Psychologist 2062840754 Practice locations: Ithaca, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1997
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

215 N Cayuga St
Ithaca, NY 14850-4377
Phone (607) 273-5522

National Provider Directory

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

NPI Registry JSON

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

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1972720894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 N CAYUGA ST",
            "address_2": "SUITE 209",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148504329",
            "telephone_number": "607-273-5522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 N CAYUGA ST",
            "address_2": "SUITE 209",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148504329",
            "telephone_number": "607-273-5522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SKROVAN",
        "first_name": "JOHN",
        "middle_name": "C",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "014942",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ithaca, NY

Sources for this page

Verify at the official NPI Registry.