Active NPI
Linda Renee Bockheim
- Clinical Psychologist
- Albany, OR
National Provider Identifier
1013417286
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2935
- Practice address
- 425 2ND Ave SW Ste 204
Albany, OR 97321-2485 - Phone
- (541) 248-9153
- NPI assigned
- Feb 14, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2935 | OR | Primary |
Addresses
Primary practice location
425 2ND Ave SW Ste 204
Albany, OR 97321-2485
Mailing address
425 2ND Ave SW Ste 204
Albany, OR 97321-2485
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500743734 | Medicaid | OR | |
| 500761237 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 4, 2021 through Jan 4, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2935 | OR | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mosaic Psychological, LLC | Clinical | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1518566400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1013417286",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "425 2ND AVE SW STE 204",
"city": "ALBANY",
"state": "OR",
"postal_code": "973212485"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "425 2ND AVE SW STE 204",
"city": "ALBANY",
"state": "OR",
"postal_code": "973212485",
"telephone_number": "541-248-9153"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOCKHEIM",
"first_name": "LINDA",
"middle_name": "RENEE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-02-14",
"last_updated": "2022-07-21",
"certification_date": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "2935",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500743734",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500761237",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Albany, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.