Active NPI
Charles Hermann Bogdahn, LCSW
- Clinical Child & Adolescent Psychologist
- Mount Vernon, WA
National Provider Identifier
1265770523
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- #615
- Practice address
- 1419 East College Way
Mount Vernon, WA 98273 - Phone
- (808) 688-3376
- Fax
- (808) 961-6819
- NPI assigned
- Jan 22, 2013
- 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 Child & Adolescent Psychologist | 103TC2200X | #615 | HI | Primary |
Addresses
Primary practice location
1419 East College Way
Mount Vernon, WA 98273
Mailing address
PO Box 591
Pepeekeo, HI 96783
Phone (808) 688-3376
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in HI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150811004923 | HI | Practitioner - Clinical Social Worker | 8325353915 | Practice locations: Hilo, HI |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 1995
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
PO Box
Suite 591
Pepeekeo, HI 96783
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| #615 | HI | MD | Clinical Child & Adolescent Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dept. of Health-Hawaii-Child and Adolescent Mental Health Division | 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.
-
- Community/Behavioral Health Agency
- Hilo, HI
- NPI 1518234582
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1358812800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1673136000000",
"number": "1265770523",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 591",
"city": "PEPEEKEO",
"state": "HI",
"postal_code": "96783",
"telephone_number": "808-688-3376",
"fax_number": "808-961-6819"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1419 EAST COLLEGE WAY",
"city": "MOUNT VERNON",
"state": "WA",
"postal_code": "98273",
"telephone_number": "808-688-3376",
"fax_number": "808-961-6819"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOGDAHN",
"first_name": "CHARLES",
"middle_name": "HERMANN",
"name_prefix": "Dr.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-01-22",
"last_updated": "2023-01-08",
"certification_date": "2023-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "HI",
"license": "#615",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Vernon, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 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.