DR. JONATHAN WALDRON PHD
NPI 1427425065
Psychologist in San Rafael, CA

Active since August 31, 2015PECOS Enrolled
111 SMITH RANCH RD, SAN RAFAEL, CA 94903(415) 491-3000 Get Directions Write a Review

NPPES record last updated: January 3, 2022. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jan 3, 2022, Mar 6, 2018 (2 updates tracked since 2018).

About Dr. Jonathan Waldron Phd NPPES

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

DR. JONATHAN WALDRON PHD (NPI 1427425065) is an individual psychologist in San Rafael, California and active in the NPI registry since August 2015. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1427425065
Entity TypeIndividualMale
Primary Taxonomy103T00000X
Provider Legal NameDR. JONATHAN WALDRONCredential: PHD
Location Address111 SMITH RANCH RDSan Rafael, CA 94903-1939
Mailing Address111 Smith Ranch RdSan Rafael, CA 94903-1939 · (415) 491-3000
Sole ProprietorNo
Enumeration DateAugust 31, 2015
Last NPPES UpdateJanuary 3, 20222 updates tracked since enumeration
✔ NPI 1427425065 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
Definition
A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.
111 SMITH RANCH RD, San Rafael, CA 94903

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Jonathan Waldron Phd is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

Medicare Billing Reassignment

Medicare enrollment records show Jonathan Waldron reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Internal Medicine
901 NEVIN
Richmond, CA 94801
  • Reassigned Medicare billing, California enrollment
  • 20,078 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.

Other Providers at the Same Location NPPES 20

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

Psychologist
111 SMITH RANCH RD
SAN RAFAEL, CA 94903
Psychiatry & Neurology (Psychiatry)
111 SMITH RANCH RD
SAN RAFAEL, CA 94903
Marriage & Family Therapist
111 SMITH RANCH RD
SAN RAFAEL, CA 94903
Marriage & Family Therapist
111 SMITH RANCH RD
SAN RAFAEL, CA 94903
Psychologist (Clinical)
111 SMITH RANCH RD
SAN RAFAEL, CA 94903
Psychologist
111 SMITH RANCH RD
SAN RAFAEL, CA 94903
Psychologist (Clinical Child & Adolescent)
111 SMITH RANCH RD
SAN RAFAEL, CA 94903
Psychologist
111 SMITH RANCH RD
SAN RAFAEL, CA 94903

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 Jonathan Waldron's NPI number?

The NPI number for Jonathan Waldron is 1427425065. It was assigned to this individual provider in the NPPES registry on August 31, 2015.

Where is Jonathan Waldron located?

Jonathan Waldron practices at 111 Smith Ranch Rd, San Rafael, CA 94903. The listed phone number is (415) 491-3000.

What is Jonathan Waldron's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

Is Jonathan Waldron enrolled in Medicare?

Yes. Jonathan Waldron is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Jonathan Waldron's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jonathan Waldron reassigns Medicare benefits to Permanente Medical Group Inc (Richmond, 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 Jonathan Waldron'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 Jonathan Waldron was last updated on January 3, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.