RICHARD ETTELSON PHD
NPI 1174569453
Psychologist - Clinical in Rancho Cucamonga, CA
About Richard Ettelson Phd NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
RICHARD ETTELSON PHD (NPI 1174569453) is an individual clinical provider in Rancho Cucamonga, California, licensed in California (D5418953) and active in the NPI registry since June 2006. He is enrolled in Medicare PECOS, maintains a secondary practice location in Rancho Cucamonga, and is a graduate of Other (1998).
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Location 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Richard Ettelson Phd is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignment
Medicare enrollment records show Richard Ettelson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Carlsbad, CA 92008
- Reassigned Medicare billing, California enrollment
- 223 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 91730 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 3
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
RANCHO CUCAMONGA, CA 91730
RANCHO CUCAMONGA, CA 91730
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Richard Ettelson's NPI number?
The NPI number for Richard Ettelson is 1174569453. It was assigned to this individual provider in the NPPES registry on June 22, 2006.
Where is Richard Ettelson located?
Richard Ettelson practices at 10630 Town Center Dr Ste 120, Rancho Cucamonga, CA 91730. The listed phone number is (909) 989-0901.
What is Richard Ettelson's specialty?
The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.
Is Richard Ettelson enrolled in Medicare?
Yes. Richard Ettelson is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organization bills Medicare for Richard Ettelson's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Richard Ettelson reassigns Medicare benefits to Memory Check Psychological Services, A Professional Corporation (Carlsbad, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Richard Ettelson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Richard Ettelson was last updated on September 18, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Richard Ettelson, PHD · NPI 1174569453
Clinical provider in Rancho Cucamonga, California. Individual provider, active in the CMS NPPES registry since June 22, 2006.
## Identity
- **NPI:** 1174569453 (Entity type: Individual)
- **Enumerated:** June 22, 2006
- **Primary specialty:** Psychologist - Clinical · taxonomy 103TC0700X
- **State license:** D5418953 (California)
- **Sole proprietor:** No
## Practice location
- **Address:** 10630 TOWN CENTER DR STE 120, Rancho Cucamonga, CA 91730-6889
- **Phone:** (909) 989-0901 · **Fax:** (909) 941-1087
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** Memory Check Psychological Services, A Professional Corporation (NPI 1912184219, Carlsbad, CA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 1998
## Record status
- **NPPES last updated:** September 18, 2018
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Source: [NPI Profile](https://npiprofile.com/npi/1174569453) · Data from the CMS NPPES public registry.