DR. KELLY LEIGH EDYBURN PH.D.
NPI 1801560180
Psychologist - Clinical Child & Adolescent in Oakland, CA

NPI Status: Active since August 02, 2021

Contact Information

8711 MACARTHUR BLVD
OAKLAND, CA
ZIP 94605
Phone: (510) 428-3556

NPI Profile Information
Primary Taxonomy
Medicare Participation & PECOS Status
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Individual
Female
Psychologist
Clinical Child & Adolescent
PECOS Enrolled

About KELLY EDYBURN

This page provides the complete NPI Profile along with additional information for Kelly Edyburn, a provider established in Oakland, California with a medical specialization in Psychologist, focusing in clinical child & adolescent . The healthcare provider is registered in the NPI registry with number 1801560180 assigned on August 2021. The practitioner's primary taxonomy code is 103TC2200X with license number PSY33603 (CA). The provider is registered as an individual and her NPI record was last updated 2 years ago.

NPI: 1801560180
Provider Name: DR. KELLY LEIGH EDYBURN PH.D.
Gender: Female
Entity Type: Individual
Location Address: 8711 MACARTHUR BLVD OAKLAND, CA 94605
Location Phone: (510) 428-3556
Mailing Address: 8711 MACARTHUR BLVD OAKLAND, CA 94605
Mailing Phone: (510) 428-3556
Is Sole Proprietor?: No
Enumeration Date: 08-02-2021
Last Update Date: 05-11-2023
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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.: PSY33603
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.

Medicare Participation & PECOS Enrollment Status

Kelly Edyburn is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging and Durable Medical Equipment (DME).

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.

Is the provider registered in PECOS? Yes
Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): No
Eligible to Order or Refer Power Mobility Devices: No

NPI Validation Check Digit Calculation

The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1	8	0	1	5	6	0	1	8	0
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2	8	0	1	10	6	0	1	16
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 8 + 0 + 1 + 1 + 0 + 6 + 0 + 1 + 1 + 6 + 24 = 50
Step 3: because the number obtained in step 2 ends in zero, the check digit is zero.
									0

The NPI number 1801560180 is valid because the calculated check digit 0 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location

The following 8 providers are registered at the same or nearby location.

MS. LA RAYE LYNETTE LYLES M.A.

Counselor

(Mental Health)

8711 MACARTHUR BLVD
A
OAKLAND, CA
ZIP 94605

(510) 428-3885

View Profile

L. AARON SMITH

Social Worker