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DR. GARY A BLANK PH.D.
NPI 1316160906
Psychologist - Clinical in Santa Rosa, CA

Active since April 11, 2007PECOS EnrolledAccepts Medicare Assignment
2455 BENNETT VALLEY RD, SUITE 208B, SANTA ROSA, CA 95404(707) 526-2525(707) 526-2593 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Gary A Blank Ph.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. GARY A BLANK PH.D. (NPI 1316160906) is an individual clinical provider in Santa Rosa, California, licensed in California (PSY3303) and active in the NPI registry since April 2007. He is enrolled in Medicare PECOS and is a graduate of Other (1967).

NPPES Registry Identity

NPI1316160906
Entity TypeIndividualMale
Primary Taxonomy103TC0700X
Provider Legal NameDR. GARY A BLANKCredential: PH.D.
Location Address2455 BENNETT VALLEY RD, SUITE 208BSanta Rosa, CA 95404-5663
Mailing Address2455 Bennett Valley Rd, Suite 208bSanta Rosa, CA 95404-5663 · (707) 526-2525 · Fax (707) 526-2593
Phone(707) 526-2525
Fax(707) 526-2593
Sole ProprietorYes
Medical School CMSOtherGraduated 1967
Enumeration DateApril 11, 2007
Last NPPES UpdateJuly 8, 2007
✔ NPI 1316160906 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code103TC0700X
License✔ Licensed in CA · PSY3303
Definition
A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.
2455 BENNETT VALLEY RD, Santa Rosa, CA 95404
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Other Identifiers 1

Medicare ID-Type Unspecified00PL33031CA

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Gary A Blank Ph.d. 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.

PECOS PAC ID42402588
PECOS Enrollment IDI20101004000106
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 95404 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$187.01 typical visit price
range $63.04 – $187.01
Typical copayment $46.75 (range $15.76 – $46.75)
Most-billed visit code 99205
Established Patient
$109.88 typical visit price
range $21.02 – $153.40
Typical copayment $27.47 (range $5.25 – $38.35)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 12

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PATRICK A TRAVISS LCSW
Social Worker (Clinical)
2455 BENNETT VALLEY RD, SUITE 208B
SANTA ROSA, CA 95404
Sonoma County (707) 526-2595
TRAVISS FAMILY COUNSELING
Social Worker (Clinical)
2455 BENNETT VALLEY RD, SUITE 208B
SANTA ROSA, CA 95404
Sonoma County (707) 526-2595
MERCEDES ELON HOSKINS
Psychologist
2455 BENNETT VALLEY RD
SANTA ROSA, CA 95404
Sonoma County (707) 477-6594
ADRIAN CHASE
Anesthesiology
2455 BENNETT VALLEY RD
SANTA ROSA, CA 95404
Sonoma County (707) 522-1800
ROBERT BENAVIDES JR.
Psychologist
2455 BENNETT VALLEY RD, #210 C
SANTA ROSA, CA 95404
Sonoma County (707) 542-2081
DR. CYNTHIA L KOHLES PHD
Psychologist (Clinical Child & Adolescent)
2455 BENNETT VALLEY RD, SUITE B208
SANTA ROSA, CA 95404
Sonoma County (707) 529-5942
DR. ROBERT BENAVIDES JR. ED.D.
Psychologist
2455 BENNETT VALLEY RD, SUITE 210 C
SANTA ROSA, CA 95404
Sonoma County (707) 542-2081
DR. JOSEPH CHRISTOPHER PUENTES PSY.D.
Psychologist (Clinical)
2455 BENNETT VALLEY RD, WATERFALL TOWERS SUITE B-208
SANTA ROSA, CA 95404
Sonoma County (707) 583-9663

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 Gary Blank's NPI number?

The NPI number for Gary Blank is 1316160906. It was assigned to this individual provider in the NPPES registry on April 11, 2007.

Where is Gary Blank located?

Gary Blank practices at 2455 Bennett Valley Rd Suite 208B, Santa Rosa, CA 95404. The listed phone number is (707) 526-2525.

What is Gary Blank's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Gary Blank enrolled in Medicare?

Yes. Gary Blank 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.

When was this NPI record last updated?

The NPPES record for Gary Blank was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 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.