DR. MEDRIA LOU CONNOLLY PH.D.
NPI 1164540316
Psychologist - Clinical Child & Adolescent in Santa Monica, CA
NPI Status: Active since March 26, 2007
Contact Information
2444 WILSHIRE BLVD
SUITE 500
SANTA MONICA, CA
ZIP 90403
Phone: (310) 264-2602
Fax: (310) 264-2601
- Individual
- Female
- Psychologist
- Clinical Child & Adolescent
- Opted-Out Medicare
About MEDRIA CONNOLLY
This page provides the complete NPI Profile along with additional information for Medria Connolly, a provider established in Santa Monica, California with a medical specialization in Psychologist, focusing in clinical child & adolescent . The healthcare provider is registered in the NPI registry with number 1164540316 assigned on March 2007. The practitioner's primary taxonomy code is 103TC2200X with license number PSY9977 (CA). The provider is registered as an individual and her NPI record was last updated one year ago.
- NPI
- 1164540316
- Provider Name
- DR. MEDRIA LOU CONNOLLY PH.D.
- Gender
- Female
- Entity Type
- Individual
- Location Address
- 2444 WILSHIRE BLVD SUITE 500 SANTA MONICA, CA 90403
- Location Phone
- (310) 264-2602
- Location Fax
- (310) 264-2601
- Mailing Address
- 2444 WILSHIRE BLVD SUITE 500 SANTA MONICA, CA 90403
- Mailing Phone
- (310) 264-2602
- Mailing Fax
- (310) 264-2601
- Is Sole Proprietor?
- No
- Enumeration Date
- 03-26-2007
- Last Update Date
- 09-11-2025
- Code Navigator
The provider doesn't accept Medicare and has signed an affidavit to be excluded from the Medicare program. If you are a Medicare beneficiary this means a provider can charge whatever they want for services rendered but must follow certain rules to do so. Medria Connolly opted out of Medicare effective on 12-16-2019 until 12-16-2025. Opt out periods last for two years and cannot be terminated unless the provider is opting out for the very first time and the affidavit is terminated no later than 90 days after the opt out effective date. Opt-out affidavits might renew automatically renew every two years. The provider opted out of Medicare and cannot order and refer services to other healthcare providers.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Psychologist Clinical Child & Adolescent
- Taxonomy Code
- 103TC2200X
- Type
- Behavioral Health & Social Service Providers
- License No.
- PSY9977
- License State
- CA
- Taxonomy Description
- A psychologist who develops and applies scientific knowledge to the delivery of psychological services to infants, toddlers, children and adolescents within their social context. Of particular importance to the specialty of clinical child psychology is an understanding of the basic psychological needs of children and adolescents, and how the family and other social contexts influence the socio-emotional adjustment, cognitive development, behavioral adaptation and health status of children and adolescents.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | PSY9977 (CA) |
| 2 | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | PSY9977 (CA) |
Medicare Participation & PECOS Enrollment Status
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Opted-Out of Medicare? Yes
Opt-Out Effective Date: 12-16-2019
Opt-Out End Date: 12-16-2025
Eligible to Order and Refer? No
Reviews for DR. MEDRIA LOU CONNOLLY PH.D.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1164540316, we treat the final digit (6) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 44. The final step is to find the difference between that total and the next multiple of ten (50 - 44 = 6).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 44 is 50. The difference is the calculated check digit.
Other Providers at the Same Location
The following 18 providers are registered at the same or a nearby location.
SANTA MONICA, CA 90403
SANTA MONICA, CA 90403
SANTA MONICA, CA 90403
SANTA MONICA, CA 90403
SANTA MONICA, CA 90403
SANTA MONICA, CA 90403
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1164540316, enumerated as an "individual" on March 26, 2007.
The provider is located at 2444 WILSHIRE BLVD SUITE 500 SANTA MONICA, CA 90403 and the phone number is (310) 264-2602.
Psychologist with taxonomy code 103TC2200X and a focus in Clinical Child & Adolescent.
