Individual provider Active NPI

Karine Hageboutros, PSYD

  • Clinical Psychologist
  • Phoenix, AZ
National Provider Identifier
1992378038
Registry record updated Oct 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY-005371 Issued in AZ
Practice address
222 W Thomas Rd Ste 315
Phoenix, AZ 85013-4422
Phone
(602) 406-3671
NPI assigned
Jul 16, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2024

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 PSY-005371 AZ Primary

Addresses

Primary practice location

222 W Thomas Rd Ste 315
Phoenix, AZ 85013-4422

Mailing address

240 W Thomas Rd Ste 301
Phoenix, AZ 85013-4407
Phone (602) 406-7765

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20210921002876 AZ Practitioner - Clinical Psychologist 2668879461 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sjhmc Physician ServicesGroup PAC ID 4486646197, 645 clinicians

Practice addresses (Care Compare)

500 W Thomas Rd
680 DHMG St Joseph'S Pelvic Pain and Surg
Phoenix, AZ 85013-4235
Phone (602) 406-6017

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PSY-005371AZMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Sjhmc Physician Services CurrentSince Oct 4, 2021 Accepting new patients
St. Joseph'S Hospital and Medical Center CurrentSince Aug 30, 2020 Accepting new patients
St. Joseph'S Outpatient Surgery Center, LLC Current Accepting new patients

Locations

500 W Thomas Rd
Ste 680
Phoenix, AZ 85013
Phone (602) 406-6017

240 W Thomas Rd
Ste 301
Phoenix, AZ 85013
Phone (602) 406-6262

222 W Thomas Rd
Ste 315
Phoenix, AZ 85013
Phone (602) 406-3671

File 56765
Los Angeles, CA 90074

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1626393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729468800000",
    "number": "1992378038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 W THOMAS RD STE 301",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850134407",
            "telephone_number": "602-406-7765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 W THOMAS RD STE 315",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850134422",
            "telephone_number": "602-406-3671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAGEBOUTROS",
        "first_name": "KARINE",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-16",
        "last_updated": "2024-10-21",
        "certification_date": "2024-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "AZ",
            "license": "PSY-005371",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.