NPIMap

Organization Active NPI

Robert F Burch PHD PC

  • Clinical Psychologist
  • Bend, OR
National Provider Identifier
1083859235
Registry record updated Apr 2, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
1710 Issued in OR
Legal business name
ROBERT F BURCH PHD PC
Practice address
390 SW Columbia St Ste 210
Bend, OR 97702-3227
Phone
(541) 388-9271
Fax
(541) 388-0479
NPI assigned
Dec 2, 2008
Last updated
Apr 2, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2009

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

Authorized official

Name
Robert F Burch PHD PC, PHD
Title
Owner
Phone
(541) 388-9271

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 1710 OR Primary

Addresses

Primary practice location

390 SW Columbia St Ste 210
Bend, OR 97702-3227

Mailing address

PO Box 13101
Portland, OR 97213-0101
Phone (503) 528-8404

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090409000406 OR Part B Supplier - Clinic/Group Practice 0941357891 Receives reassigned benefits from 1 practitioner
Practice locations: Bend, OR

National Provider Directory

National Provider Directory

Locations

25 NW Park Pl
Bend, OR 97703
Phone (541) 388-9271

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1228176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238630400000",
    "number": "1083859235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13101",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972130101",
            "telephone_number": "503-528-8404",
            "fax_number": "503-528-8405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "390 SW COLUMBIA ST STE 210",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977023227",
            "telephone_number": "541-388-9271",
            "fax_number": "541-388-0479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT F BURCH PHD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-02",
        "last_updated": "2009-04-02",
        "status": "A",
        "authorized_official_last_name": "BURCH PHD PC",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-388-9271",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "1710",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2009; 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.