Active NPI
Peter W B Madsen, PH.D.
- Forensic Psychologist
- Elk Grove, CA
National Provider Identifier
1982896825
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Forensic Psychologist
- License
- 29853
- Practice address
- 8220 Longleaf Dr Ste 200
Elk Grove, CA 95758-1322 - Phone
- (916) 602-9919
- NPI assigned
- Aug 14, 2007
- 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 |
|---|---|---|---|---|
| Forensic Psychologist | 103TF0200X | 29853 | CA | Primary |
Addresses
Primary practice location
8220 Longleaf Dr Ste 200
Elk Grove, CA 95758-1322
Mailing address
PO Box 11439
Oakland, CA 94611-0439
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 |
|---|---|---|---|
| 29853 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Corrections and Rehabilitation-Headquarters | Past | Accepting new patients |
Organizations & group practices 1
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.
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- San Quentin, CA
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187049600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701734400000",
"number": "1982896825",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 11439",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946110439"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8220 LONGLEAF DR STE 200",
"city": "ELK GROVE",
"state": "CA",
"postal_code": "957581322",
"telephone_number": "916-602-9919"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MADSEN",
"first_name": "PETER",
"middle_name": "W B",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-08-14",
"last_updated": "2023-12-05",
"certification_date": "2023-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "103TF0200X",
"taxonomy_group": "",
"desc": "Psychologist, Forensic",
"state": "CA",
"license": "29853",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elk Grove, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.