Individual provider Active NPI

Brock A Boekhout, PHD

  • Psychologist
  • Pittsburg, KS
National Provider Identifier
1275502148
Registry record updated Dec 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
1346 Issued in KS
Practice address
3011 N Michigan St
Pittsburg, KS 66762-2546
Phone
(620) 231-9873
Fax
(620) 231-2808
NPI assigned
Mar 14, 2006
Last updated
Dec 28, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 1346 KS Primary

Addresses

Primary practice location

3011 N Michigan St
Pittsburg, KS 66762-2546

Mailing address

PO Box 1832
Pittsburg, KS 66762-1832
Phone (620) 231-9873

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20070316000380 KS Practitioner - Clinical Psychologist 1456343680 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Texas Tech University Health Science Center School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3011 N Michigan St
Pittsburg, KS 66762-2546
Phone (620) 231-9873

3015 N Michigan St
Pittsburg, KS 66762-2546

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
1346KSMDClinical Psychologist
31725TXMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Center of Southeast Kansas Inc CurrentSince Aug 8, 2016 Accepting new patients
Community Health Center of Southeast Kansas Inc CurrentSince Aug 8, 2016 Accepting new patients
Samantha J Vigneri Psychologist Past Accepting new patients
Deer Oaks Geriatric Services P C PastSince Jan 23, 2023 Accepting new patients
Deer Oaks Mental Health Associates PC Past Accepting new patients
Vision Consulting, Inc. Psychologist Past Accepting new patients

Locations

102 Cline Rd
Coffeyville, KS 67337
Phone (620) 252-6989

1017 E Market St
Lacygne, KS 66040
Phone (913) 757-4575

3011 N Michigan St
Pittsburg, KS 66762
Phone (620) 231-1960

Interoperability endpoints

  • Direct secure messaging: brock.boekhout@chcsek.eclinicaldirectplus.com

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672185600000",
    "number": "1275502148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1832",
            "city": "PITTSBURG",
            "state": "KS",
            "postal_code": "667621832",
            "telephone_number": "620-231-9873",
            "fax_number": "620-231-2808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3011 N MICHIGAN ST",
            "city": "PITTSBURG",
            "state": "KS",
            "postal_code": "667622546",
            "telephone_number": "620-231-9873",
            "fax_number": "620-231-2808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOEKHOUT",
        "first_name": "BROCK",
        "middle_name": "A",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-14",
        "last_updated": "2022-12-28",
        "certification_date": "2022-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "KS",
            "license": "1346",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pittsburg, KS

Sources for this page

Verify at the official NPI Registry.