NPIMap

Organization Active NPI

Frederick J Tirrell PHD Professional Association

  • Psychologist
  • Leavenworth, KS
National Provider Identifier
1013076215
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
FREDERICK J TIRRELL PHD PROFESSIONAL ASSOCIATION
Practice address
3515 S 4TH Street
Leavenworth, KS 66048
Phone
(913) 651-8415
Fax
(913) 772-8580
NPI assigned
Dec 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
William Albert Moffitt, PHDNPI 1417052614
Title
Vice President Owner
Phone
(913) 651-8415

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X Primary

Addresses

Primary practice location

3515 S 4TH Street
Leavenworth, KS 66048

Mailing address

3515 S 4TH Street
Leavenworth, KS 66048
Phone (913) 651-8415

Other identifiers 2

IdentifierTypeStateIssuer
08422011OtherKSBCBS KANSAS CITY
004517OtherKSBCBS KANSAS

Other names 1

  • Professional Association Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050330000383 KS Part B Supplier - Clinic/Group Practice 8224017157 Receives reassigned benefits from 4 practitioners
Practice locations: Leavenworth, KS; Olathe, KS

National Provider Directory

National Provider Directory

Locations

3515 S 4th St
Ste 101
Leavenworth, KS 66048
Phone (913) 651-8415

3515 S 4th St
Leavenworth, KS 66048
Phone (913) 651-8415

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1013076215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3515 S 4TH STREET",
            "city": "LEAVENWORTH",
            "state": "KS",
            "postal_code": "66048",
            "telephone_number": "913-651-8415",
            "fax_number": "913-772-8580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3515 S 4TH STREET",
            "city": "LEAVENWORTH",
            "state": "KS",
            "postal_code": "66048",
            "telephone_number": "913-651-8415",
            "fax_number": "913-772-8580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREDERICK J TIRRELL PHD PROFESSIONAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MOFFITT",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "ALBERT",
        "authorized_official_title_or_position": "VICE PRESIDENT OWNER",
        "authorized_official_telephone_number": "913-651-8415",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS KANSAS CITY",
            "identifier": "08422011",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS KANSAS",
            "identifier": "004517",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Professional Association",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Leavenworth, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.