Richard C Adams, PSYD
Individual provider Active NPI Psychologist · Bolivar, MO
NPI 1205925427 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1205925427
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 2006029874 (MO)
- Practice address
- 714 N Pomme de Terre Ave
Bolivar, MO 65613-1241 - Phone
- (417) 326-7272
- Fax
- (417) 326-2193
- NPI assigned
- Oct 12, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130104000461 | MO | Practitioner - Clinical Psychologist | 0042210379 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2006029874 | MO | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Citizens Memorial Hospital District | Current |
Accepting new patients | |
| Citizens Memorial Hospital District | Current |
Accepting new patients | |
| Citizens Memorial Healthcare | Current |
Accepting new patients | |
| Citizens Memorial Healthcare | Current |
Accepting new patients | |
| Comprehensive Wellness Clinic | Past | Accepting new patients | |
| Northwoods Psychiatric Services Inc | Past | Accepting new patients |
Locations
1500 N Oakland Ave
Bolivar, MO 65613
Phone (417) 326-6000
1521 3rd Rd
Stockton, MO 65785
Phone (417) 276-2401
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 2006029874 | MO | Yes |
Addresses
Primary practice location
714 N Pomme de Terre Ave
Bolivar, MO 65613-1241
Mailing address
714 N Pomme de Terre Ave
Bolivar, MO 65613-1241
Phone (417) 326-7272
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2006029874 | Other | MO | STATE LICENSE NUMBER/PSYD |
Other providers in Bolivar, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.