NPIMap

Organization Active NPI

Chestnut Park Professionals, LLC

  • Psychologist
  • Bowling Green, KY
National Provider Identifier
1265574396
Registry record updated Apr 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
0670 Issued in KY
Legal business name
CHESTNUT PARK PROFESSIONALS, LLC
Practice address
1215 High St
Bowling Green, KY 42101-2541
Phone
(270) 782-1116
Fax
(270) 782-9108
NPI assigned
Feb 13, 2007
Last updated
Apr 12, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2012

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

Authorized official

Name
Dr. Corrie J Vos, PH.D.NPI 1861560468
Title
Owner
Phone
(270) 782-1116

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 0670 KY Primary

Addresses

Primary practice location

1215 High St
Bowling Green, KY 42101-2541

Mailing address

1215 High St
Bowling Green, KY 42101-2541
Phone (270) 782-1116

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051026000749 KY Part B Supplier - Clinic/Group Practice 8921025230 Receives reassigned benefits from 6 practitioners
Practice locations: Bowling Green, KY

National Provider Directory

National Provider Directory

Locations

1215 High St
Bowling Green, KY 42101
Phone (270) 782-1116

Practitioners & affiliated clinicians

Practitioners 27

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.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334188800000",
    "number": "1265574396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 HIGH ST",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421012541",
            "telephone_number": "270-782-1116",
            "fax_number": "270-782-9108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 HIGH ST",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421012541",
            "telephone_number": "270-782-1116",
            "fax_number": "270-782-9108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHESTNUT PARK PROFESSIONALS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2012-04-12",
        "status": "A",
        "authorized_official_last_name": "VOS",
        "authorized_official_first_name": "CORRIE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "270-782-1116",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "KY",
            "license": "0670",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowling Green, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2012; 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.