Active NPI
Tineke Carman Vandegrift, PSY.D.
- Clinical Psychologist
- Concord, MA
National Provider Identifier
1992864110
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 7174
- Practice address
- 30 Domino Dr Ste 2
Concord, MA 01742-2802 - Phone
- (978) 263-1611
- Fax
- (978) 776-2321
- NPI assigned
- Dec 6, 2006
- Sex
- Female
- 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 | 7174 | MA | Primary |
Addresses
Primary practice location
30 Domino Dr Ste 2
Concord, MA 01742-2802
Mailing address
PO Box 664
Acton, MA 01720-0664
Phone (978) 263-1611
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| W05812 | Other | MA | BLUE CROSS BLUE SHIELD |
| 250942000 | Other | MA | MAGELLAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120130000085 | MA | Practitioner - Clinical Psychologist | 4183881410 | Practice locations: Concord, MA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1993
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
30 Domino Dr
Suite 2
Concord, MA 01742-2802
Phone (978) 263-1611
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7174 | MA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165363200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1464912000000",
"number": "1992864110",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 664",
"city": "ACTON",
"state": "MA",
"postal_code": "017200664",
"telephone_number": "978-263-1611",
"fax_number": "978-776-2321"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 DOMINO DR STE 2",
"city": "CONCORD",
"state": "MA",
"postal_code": "017422802",
"telephone_number": "978-263-1611",
"fax_number": "978-776-2321"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDEGRIFT",
"first_name": "TINEKE",
"middle_name": "CARMAN",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-06",
"last_updated": "2016-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "7174",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "W05812",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN",
"identifier": "250942000",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Concord, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2016; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.