NPIMap

Individual provider Active NPI

Robert L Coffman, PSYD

  • Clinical Neuropsychologist
  • Bolivar, MO
National Provider Identifier
1306190913
Registry record updated Jan 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
2019045868 Issued in MO
Practice address
1245 N Butterfield Rd Ste C1
Bolivar, MO 65613-3017
Phone
(417) 327-3530
Fax
(417) 327-3543
NPI assigned
Nov 5, 2012
Sex
Male
Sole proprietor
No

Organizations & group practices 14

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Citizens Memorial Healthcare 144 clinicians

Practice addresses (Care Compare)

Bolivar, MO 65613
Phone (417) 328-6631

Hospital & facility affiliations

  • Citizens Memorial Hospital Hospital, Bolivar, MO, CCN 260195

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
I20200510000183 MO Practitioner - Clinical Psychologist 1153752076 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2019045868MOMDClinical Neuropsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Citizens Memorial Healthcare CurrentSince Mar 1, 2020 Accepting new patients
Citizens Memorial Healthcare CurrentSince Mar 1, 2020 Accepting new patients

Locations

1245 N Butterfield Rd
Ste C1
Bolivar, MO 65613
Phone (417) 327-3530

1500 N Oakland Ave
Bolivar, MO 65613
Phone (417) 326-6000

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X 2019045868 MO Primary

Addresses

NPPES NPI Registry

Primary practice location

1245 N Butterfield Rd Ste C1
Bolivar, MO 65613-3017

Mailing address

1245 N Butterfield Rd Ste C1
Bolivar, MO 65613-3017
Phone (417) 327-3530

Other practice location 1

8072 Normandy Dr
Ft Riley, KS 66442-7069
Phone (785) 239-3627

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 29, 2020.

{
    "created_epoch": "1352073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580256000000",
    "number": "1306190913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1245 N BUTTERFIELD RD STE C1",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656133017",
            "telephone_number": "417-327-3530",
            "fax_number": "417-327-3543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1245 N BUTTERFIELD RD STE C1",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656133017",
            "telephone_number": "417-327-3530",
            "fax_number": "417-327-3543"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8072 Normandy Dr",
            "address_purpose": "LOCATION",
            "city": "Ft Riley",
            "state": "KS",
            "postal_code": "664427069",
            "country_code": "US",
            "telephone_number": "785-239-3627",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COFFMAN",
        "first_name": "ROBERT",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-11-05",
        "last_updated": "2020-01-29",
        "certification_date": "2020-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "MO",
            "license": "2019045868",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bolivar, MO

Sources for this page

Verify at the official NPI Registry.