NPIMap

Organization Active NPI

State of Missouri

Doing business as Developmental Disabilities Behavior Services

  • Psychiatry Physician
  • Kansas City, MO
National Provider Identifier
1386198448
Registry record updated Oct 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
STATE OF MISSOURI
Doing business as
Developmental Disabilities Behavior Services
Practice address
821 Admiral Blvd
Kansas City, MO 64106-1516
Phone
(816) 889-3400
Fax
(816) 889-3325
NPI assigned
Aug 6, 2016
Last updated
Oct 27, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
STATE OF MISSOURIAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 27, 2020

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

Authorized official

Name
Molly Jane Boeckmann
Title
Director of Administrative Services
Phone
(573) 751-4055

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X NU Primary

Addresses

Primary practice location

821 Admiral Blvd
Kansas City, MO 64106-1516

Mailing address

PO Box 687
Attn: Reimbursement Section
Jefferson City, MO 65102-0687
Phone (573) 751-3395

Other names 1

  • Developmental Disabilities Behavior Services Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040609001176 MO Part B Supplier - Clinic/Group Practice 1456254226 Receives reassigned benefits from 18 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kansas City, MO; Marshall, MO; Nevada, MO; Saint Joseph, MO; Higginsville, MO

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Missouri Tuberculosis Lab

Locations

600 E 22nd St
Kansas City, MO 64108
Phone (816) 471-3000

821 Admiral Blvd
Kansas City, MO 64106
Phone (816) 889-3400

700 E Slater St
Marshall, MO 65340
Phone (660) 886-2202

2041 E Hunter St
Nevada, MO 64772
Phone (417) 667-7833

11 Brady Cir
#1
Overland, MO 63114
Phone (314) 877-1621

211 N Lindbergh Blvd
Saint Louis, MO 63141
Phone (314) 427-2237

2312 Lemay Ferry Rd
Saint Louis, MO 63125
Phone (314) 340-6702

Practitioners & affiliated clinicians

Practitioners 99

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 99

NPI Registry JSON

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

{
    "created_epoch": "1470441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603756800000",
    "number": "1386198448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 687",
            "address_2": "ATTN: REIMBURSEMENT SECTION",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651020687",
            "telephone_number": "573-751-3395",
            "fax_number": "573-526-4560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "821 ADMIRAL BLVD",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641061516",
            "telephone_number": "816-889-3400",
            "fax_number": "816-889-3325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF MISSOURI",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATE OF MISSOURI",
        "enumeration_date": "2016-08-06",
        "last_updated": "2020-10-27",
        "certification_date": "2020-10-27",
        "status": "A",
        "authorized_official_last_name": "BOECKMANN",
        "authorized_official_first_name": "MOLLY",
        "authorized_official_middle_name": "JANE",
        "authorized_official_title_or_position": "DIRECTOR OF ADMINISTRATIVE SERVICES",
        "authorized_official_telephone_number": "573-751-4055"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Developmental Disabilities Behavior Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Developmental Disabilities Behavior Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kansas City, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.