Active NPI
Bernice Laverne Collins, PH.D.
- Clinical Psychologist
- East Saint Louis, IL
National Provider Identifier
1073529020
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- Practice address
- 605 Vogel PL
East Saint Louis, IL 62205-2132 - Phone
- (618) 482-7990
- Fax
- (618) 271-6853
- NPI assigned
- Jul 31, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 | IL | Primary |
Addresses
Primary practice location
605 Vogel PL
East Saint Louis, IL 62205-2132
Mailing address
605 Vogel PL
East Saint Louis, IL 62205-2132
Phone (618) 482-7990
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 08272004 | Other | IL | BLUE CROSS/BLUE SHIELD # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101221000107 | IL | Practitioner - Clinical Psychologist | 1658569421 | Practice locations: East St Louis, IL |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1981
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
605 Vogel PL
East Saint Louis, IL 62205-2132
605 Vogel Place
East St Louis, IL 62205-2132
Phone (618) 482-7990
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071003102 | IL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1073529020",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "605 VOGEL PL",
"city": "EAST SAINT LOUIS",
"state": "IL",
"postal_code": "622052132",
"telephone_number": "618-482-7990",
"fax_number": "618-271-6853"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "605 VOGEL PL",
"city": "EAST SAINT LOUIS",
"state": "IL",
"postal_code": "622052132",
"telephone_number": "618-482-7990",
"fax_number": "618-271-6853"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLLINS",
"first_name": "BERNICE",
"middle_name": "LAVERNE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS/BLUE SHIELD #",
"identifier": "08272004",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in East Saint Louis, IL
- Childrens Home & Aid Soc of Il
- Choice Community Care, Inc.
- Alicia Michelle Collier
- Laura A. Collier, CNP
- Sandra M Collier, MSW, LCSW
- Comprehensive Behavioral Health Center
- Comprehensive Behavioral Health Center of St. Clair County, Inc.
- Comprehensive Behavioral Health Center of St. Clair County, Inc.
- Comprehensive Behavioral Health Center of St. Clair County, Inc.
- Comprehensive Behavioral Health Center of St. Clair County, Inc.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.