Individual provider Active NPI

Paul A Vanportfliet, PSY.D.

  • Psychologist
  • San Diego, CA
National Provider Identifier
1982885158
Registry record updated Oct 31, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PSY31384 Issued in CA
Practice address
1465 30TH St
Suite K
San Diego, CA 92154-3497
Phone
(619) 428-1000
NPI assigned
Nov 16, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY31384 CA
Psychologist 103T00000X PSY31384 CA Primary

Addresses

Primary practice location

1465 30TH St
Suite K
San Diego, CA 92154-3497

Mailing address

1465 30TH St
Suite K
San Diego, CA 92154-3497
Phone (619) 428-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20200409000566 CA Practitioner - Clinical Psychologist 5890124044 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PSY31384CAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Family Health Centers of San Diego Inc CurrentSince Mar 27, 2020 Accepting new patients
Family Health Centers of San Diego, Inc Current Accepting new patients
Clear Direction Psychological Services, Inc Current Accepting new patients
Family Health Centers of San Diego, Inc CurrentSince Mar 27, 2020 Accepting new patients
Canvas of Possibilities Psychological Services Inc. Past Accepting new patients

Locations

823 Gateway Center Way
San Diego, CA 92102
Phone (619) 515-2323

1550 Broadway
#2
San Diego, CA 92101
Phone (619) 515-2525

1809 National Ave
San Diego, CA 92113
Phone (619) 515-2500

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1195171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572480000000",
    "number": "1982885158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1465 30TH ST",
            "address_2": "SUITE K",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921543497",
            "telephone_number": "619-428-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1465 30TH ST",
            "address_2": "SUITE K",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921543497",
            "telephone_number": "619-428-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANPORTFLIET",
        "first_name": "PAUL",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-16",
        "last_updated": "2019-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY31384",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY31384",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.