Active NPI
Scott Gregory Koeneman, PSY.D.
- Clinical Psychologist
- Olathe, KS
National Provider Identifier
1356676811
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1866
- Practice address
- 2030 E College Way
Olathe, KS 66062-1851 - Phone
- (913) 956-8888
- NPI assigned
- Oct 16, 2009
- Last updated
- Mar 19, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2008032449 | MO | |
| Clinical Psychologist | 103TC0700X | 1866 | KS | Primary |
Addresses
Primary practice location
2030 E College Way
Olathe, KS 66062-1851
Mailing address
PO Box 4755
Olathe, KS 66063-4755
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Apr 1, 2018 through Apr 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1866 | KS | MD | Mental Health Counselor |
| 2008032449 | MO | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1255651200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1363651200000",
"number": "1356676811",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4755",
"city": "OLATHE",
"state": "KS",
"postal_code": "660634755"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2030 E COLLEGE WAY",
"city": "OLATHE",
"state": "KS",
"postal_code": "660621851",
"telephone_number": "913-956-8888"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOENEMAN",
"first_name": "SCOTT",
"middle_name": "GREGORY",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-10-16",
"last_updated": "2013-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MO",
"license": "2008032449",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "KS",
"license": "1866",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Olathe, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2013; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.