Robert Bruce Fane, ED.D

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

1104 Issued in KY

Practice address

1011 Lehman Ave
Suite 103
Bowling Green, KY 42103-6515

Phone

(270) 393-9833

Fax

(270) 393-9835

NPI assigned

Oct 2, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Robert Fane Agency LLCPGroup PAC ID 5496150526, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Robert Fane Agency, LLCP

  • Clinical Child & Adolescent Psychologist
  • Bowling Green, KY
  • NPI 1639341126

  Clinical Child & Adolescent, KY

  Medicare reassignment Care Compare group NPD Authorized official
• Cpcfs/Robert Fane Agency

  • Community/Behavioral Health Agency
  • Bowling Green, KY
  • NPI 1518239862
  NPD (past) Authorized official
• Chestnut Park Professionals, LLC

  • Psychologist
  • Bowling Green, KY
  • NPI 1265574396
  NPD (past)
• Wilson Counseling LLC

  • Clinical Social Worker
  • Bowling Green, KY
  • NPI 1427480060
  NPD (past)

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386720000000",
    "number": "1144313248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 LEHMAN AVE",
            "address_2": "SUITE 103",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421036515",
            "telephone_number": "270-393-9833",
            "fax_number": "270-393-9835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 LEHMAN AVE",
            "address_2": "SUITE 103",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421036515",
            "telephone_number": "270-393-9833",
            "fax_number": "270-393-9835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANE",
        "first_name": "ROBERT",
        "middle_name": "BRUCE",
        "name_prefix": "Mr.",
        "credential": "ED.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2013-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "KY",
            "license": "1104",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Family Restorations LLC
• Familyworks Therapy, LLC
• Courtney Fancher
• Chandler Sloan Fane, MD
• Meredith Michelle Fane, CSW
• Rachael Lynn Fantasia
• Nazaneen Farahani
• Lynn Farlee, RBT
• John Farmer, PHARM.D.
• Mary Elizabeth Farmer, L.M.F.T., PH. D.

• All providers in Bowling Green, KY
• Clinical Child & Adolescent Psychologist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2013; 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.

Verify at the official NPI Registry.