DR. JAE LEE ROSS (PSY.D.) – Clinical Psychologist, NPI 1063708188
Clinical Psychologist
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Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
2,461 CLINICAL PSYCHOLOGIST in NY
Provider Addresses for DR. JAE LEE ROSS (PSY.D.)
PO BOX 844658
DALLAS, TX 752844658
Phone: (254) 724-8800
Type: Mailing
633 3RD AVE
NEW YORK, NY 100176706
Phone: (646) 227-3764
Type: Mailing
1275 YORK AVE
NEW YORK, NY 100656007
Phone: (212) 639-2000
Type: Location
2401 S 31ST ST
TEMPLE, TX 765080001
Phone: (254) 724-2585
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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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: 2023-11-01
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 |
|---|---|---|---|---|
| I20231016002744 | I | Clinical Psychologist | NJ | TBD |
| I20231101003734 | I | Clinical Psychologist | NY | 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 |
|---|---|---|---|---|
| 90791 | Psychiatric diagnostic evaluation | 18 | 18 | $0 |
Insurance plans in this area (ZIP 75284)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physical Medicine And Rehabilitation | NY | |
| - | NY | |
| Interventional Radiology, Diagnostic Radiology | NY | |
| Diagnostic Radiology | NC | |
| Nurse Practitioner | NY | |
| Nurse Practitioner | NJ | |
| Anesthesiology, Internal Medicine, Pain Management, Pain Management, Anesthesiology | NJ | |
| Nurse Practitioner | NY | |
| Medical Oncology | NY | |
| Nurse Practitioner | NJ |
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