ANDREW POTTER, PH.D., PSYCHOLOGIST, INC. — NPI 1043814288 (Licensed & Credentialed Behavioral Health & Social Service Providers

CMS-1500 Box 24J / 33a • NPI

1043814288

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

103T00000X (CMS 62)

Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist

Box 32 Service Location & ZIP+4

1460 MARIA LN STE 300, WALNUT CREEK, CA, 94596-5314

✓ 9-Digit EDI 837 ZIP+4 (94596-5314)

Practice Phone & Referral Fax

(617) 816-1818

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1043814288 (ANDREW POTTER, PH.D., PSYCHOLOGIST, INC.) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1043814288` (NPI-2 Organization / Facility)
Provider / Legal Name	ANDREW POTTER, PH.D., PSYCHOLOGIST, INC.
Plain-English Specialty	Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist NUCC Code: `103T00000X` (Psychologist)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	1460 MARIA LN STE 300, WALNUT CREEK, CA, 94596-5314
Practice Telephone / Fax	Tel: (617) 816-1818
Administrative Mailing Address	2320 SARITA CT, PINOLE, CA, 94564-1527
Enumeration & Last Sync	Enumerated: 2020-11-29 \| CMS Record Updated: 2020-11-29
Authorized Official	ANDREW POTTER (Psychologist)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

1460 MARIA LN STE 300, WALNUT CREEK, CA, 94596-5314

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Plain-English Taxonomy & CMS Crosswalk (103T00000X)

What Does Taxonomy Code 103T00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 103T00000X translates to:
"Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 62 (Psychologist, Clinical)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Psychologist for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (ANDREW POTTER, PH.D., PSYCHOLOGIST, INC.)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`103TB0200X` — Psychologist, Cognitive & Behavioral Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Cognitive & Behavioral	State: N/A \| License: `Verified` \| Primary: Secondary
`103TC1900X` — Psychologist, Counseling Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Counseling	State: N/A \| License: `Verified` \| Primary: Secondary
`103TC2200X` — Psychologist, Clinical Child & Adolescent Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Clinical Child & Adolescent	State: N/A \| License: `Verified` \| Primary: Secondary
`103TF0000X` — Psychologist, Family Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Family	State: N/A \| License: `Verified` \| Primary: Secondary
`103TS0200X` — Psychologist, School Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, School	State: N/A \| License: `Verified` \| Primary: Secondary
`103T00000X` — Psychologist Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

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ANDREW POTTER, PH.D., PSYCHOLOGIST, INC. (NPI #1043814288)