Active NPI
Robert J Dieckhoff
- Clinical Social Worker
- Mount Vernon, MO
National Provider Identifier
1124291679
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 003822
- Practice address
- 216 Kevin Cir
Mount Vernon, MO 65712-9781 - Phone
- (417) 466-0530
- Fax
- (417) 667-2410
- NPI assigned
- Apr 4, 2008
- Sex
- Male
- 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 Social Worker | 1041C0700X | 003822 | MO | Primary |
Addresses
Primary practice location
216 Kevin Cir
Mount Vernon, MO 65712-9781
Mailing address
216 Kevin Cir
Mount Vernon, MO 65712-9781
Phone (417) 466-0530
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000078773 | Other | MO | MEDICARE |
Other names 1
- Robert J Dieckhoff
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 003822 | MO | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| New Life Counseling Services 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": "1207267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1207267200000",
"number": "1124291679",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "216 KEVIN CIR",
"city": "MOUNT VERNON",
"state": "MO",
"postal_code": "657129781",
"telephone_number": "417-466-0530",
"fax_number": "417-667-2410"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "216 KEVIN CIR",
"city": "MOUNT VERNON",
"state": "MO",
"postal_code": "657129781",
"telephone_number": "417-466-0530",
"fax_number": "417-667-2410"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIECKHOFF",
"first_name": "ROBERT",
"middle_name": "J",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-04-04",
"last_updated": "2008-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MO",
"license": "003822",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "000078773",
"state": "MO"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "ROBERT",
"last_name": "DIECKHOFF",
"middle_name": "J",
"credential": "LCSW",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Mount Vernon, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.