Active NPI
Richard L Bossardt, L.C.S.W.
- Clinical Social Worker
- Coos Bay, OR
National Provider Identifier
1336245752
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 350194
- Practice address
- 2085 Thompson Rd
Coos Bay, OR 97420-2085 - Phone
- (541) 269-5333
- Fax
- (541) 269-5609
- NPI assigned
- Sep 15, 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 350194 | OR | Primary |
Addresses
Primary practice location
2085 Thompson Rd
Coos Bay, OR 97420-2085
Mailing address
2085 Thompson Rd
Coos Bay, OR 97420-2085
Phone (541) 269-5333
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 35 0194 | Other | OR | CLINICAL SOCIAL WORKERS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 350194 | OR | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bay Area Hospital District | 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.
-
- Home Health Agency
- North Bend, OR
- NPI 1215018197
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158278400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1280275200000",
"number": "1336245752",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2085 THOMPSON RD",
"city": "COOS BAY",
"state": "OR",
"postal_code": "974202085",
"telephone_number": "541-269-5333",
"fax_number": "541-269-5609"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2085 THOMPSON RD",
"city": "COOS BAY",
"state": "OR",
"postal_code": "974202085",
"telephone_number": "541-269-5333",
"fax_number": "541-269-5609"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOSSARDT",
"first_name": "RICHARD",
"middle_name": "L",
"name_prefix": "Mr.",
"credential": "L.C.S.W.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-15",
"last_updated": "2010-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OR",
"license": "350194",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CLINICAL SOCIAL WORKERS",
"identifier": "35 0194",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Coos Bay, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.