Active NPI
Bruce Daniel Kobal, PH.D.
- Psychologist
- Erie, PA
National Provider Identifier
1205935889
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PS006269L
- Practice address
- 3939 W Ridge Rd # B47
Erie, PA 16506-1879 - Phone
- (814) 923-8140
- Fax
- (814) 315-6044
- NPI assigned
- Sep 21, 2006
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PS006269L | PA | Primary |
Addresses
Primary practice location
3939 W Ridge Rd # B47
Erie, PA 16506-1879
Mailing address
3939 W Ridge Rd # B47
Erie, PA 16506-1879
Phone (814) 923-8410
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 114436 | Other | PA | VALUEOPTIONS |
| 000505965 | Other | PA | HIMARK BC/BS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
3939 W Ridge Rd
Suite B47
Erie, PA 16506-1879
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1682640000000",
"number": "1205935889",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3939 W RIDGE RD # B47",
"city": "ERIE",
"state": "PA",
"postal_code": "165061879",
"telephone_number": "814-923-8410",
"fax_number": "814-315-6044"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3939 W RIDGE RD # B47",
"city": "ERIE",
"state": "PA",
"postal_code": "165061879",
"telephone_number": "814-923-8140",
"fax_number": "814-315-6044"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOBAL",
"first_name": "BRUCE",
"middle_name": "DANIEL",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-21",
"last_updated": "2023-04-28",
"certification_date": "2023-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "PA",
"license": "PS006269L",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUEOPTIONS",
"identifier": "114436",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HIMARK BC/BS",
"identifier": "000505965",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Erie, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2023; 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.