Active NPI
Kent A Hershberger, HSPP
- Clinical Psychologist
- South Bend, IN
National Provider Identifier
1992749709
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 20041322A
- Practice address
- 150 W Angela Blvd
South Bend, IN 46617-1101 - Phone
- (574) 220-4968
- NPI assigned
- Jun 15, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 Psychologist | 103TC0700X | 20041322A | IN | Primary |
Addresses
Primary practice location
150 W Angela Blvd
South Bend, IN 46617-1101
Mailing address
150 W Angela Blvd
South Bend, IN 46617-1101
Phone (574) 220-4968
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200264420 | Medicaid | IN | |
| 000000202186 | Other | IN | ANTHEM |
| 200288970 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20041322A | IN | MD | Clinical Psychologist |
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Elkhart, IN
- NPI 1598847212
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1308528000000",
"number": "1992749709",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "150 W ANGELA BLVD",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466171101",
"telephone_number": "574-220-4968"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "150 W ANGELA BLVD",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466171101",
"telephone_number": "574-220-4968"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERSHBERGER",
"first_name": "KENT",
"middle_name": "A",
"credential": "HSPP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-15",
"last_updated": "2011-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IN",
"license": "20041322A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200264420",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000202186",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200288970",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.