PATCHAWAN PHUNWUTIKORN (PSYD) – Mental Health Counselor, NPI 1114455706
Mental Health Counselor
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
4,434 CLINICAL PSYCHOLOGIST in CA
Provider Addresses for PATCHAWAN PHUNWUTIKORN (PSYD)
2325 Clement Ave Ste A
Alameda, CA 945017061
Phone: (510) 629-6367
Type: Location
2004 FOX HILL DR APT 1
GRAND BLANC, MI 484395244
Phone:
Type: Mailing
Genesys Regional Medical Center, 1, Genesys Parkway, Genesee County, Michigan, 48439, United States
GRAND BLANC, MI 484398065
Phone: (810) 606-5126
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2023-11-16
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20210812000317 | I | Clinical Psychologist | MI | TBD |
| I20231116000105 | I | Clinical Psychologist | VA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 90832 | Psychotherapy, 30 minutes | 28 | 14 | $0 |
| 90791 | Psychiatric diagnostic evaluation | 16 | 16 | $0 |
Insurance plans in this area (ZIP 94501)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Clinical Psychologist | MI | |
| Clinical Psychologist | VA | |
| Clinical Psychologist | OH | |
| Clinical Social Worker | OH | |
| Mental Health Counselor | SC | |
| Clinical Psychologist | GA | |
| Clinical Psychologist | CT | |
| Clinical Psychologist | NC | |
| Clinical Psychologist | OH | |
| Clinical Psychologist | PA |
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