NPIMap

Individual provider Active NPI

Amanda Cowart Derham, LCSW

  • Mental Health Counselor
  • Springfield, MO
National Provider Identifier
1477049930
Registry record updated Jan 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
2006025361 Issued in MO
Practice address
1300 E Bradford Pkwy
Springfield, MO 65804
Phone
(417) 761-5000
Fax
(417) 761-5065
NPI assigned
Jul 9, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 2006025361 MO Primary

Addresses

Primary practice location

1300 E Bradford Pkwy
Springfield, MO 65804

Mailing address

1300 E Bradford Pkwy
Springfield, MO 65804-4264
Phone (417) 761-5000

Other names 1

  • Amanda Cowart Jones Former name

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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180830003761 MO Practitioner - Clinical Social Worker 4183974777 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Advocates for a Healthy Community Inc CurrentSince Jan 7, 2019 Accepting new patients
Advocates for a Healthy Community, Inc CurrentSince Jan 7, 2019 Accepting new patients

Locations

440 E Tampa St
Springfield, MO 65806
Phone (417) 831-0191

Interoperability endpoints

  • Direct secure messaging: jessica.derham.p1@direct.jordanvalley.nextgenshare.com

Organizations & group practices 10

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.

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advocates for a Healthy Community Inc 55 clinicians

Practice addresses (Care Compare)

1720 W Grand St
Suite a
Springfield, MO 65802-4802
Phone (417) 851-1625

1720 W Grand St B
Springfield, MO 65802-4802
Phone (417) 851-1625

NPI Registry JSON

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

{
    "created_epoch": "1531094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547510400000",
    "number": "1477049930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 E BRADFORD PKWY",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658044264",
            "telephone_number": "417-761-5000",
            "fax_number": "417-761-5065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 E BRADFORD PKWY",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "65804",
            "telephone_number": "417-761-5000",
            "fax_number": "417-761-5065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERHAM",
        "first_name": "AMANDA",
        "middle_name": "COWART",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-09",
        "last_updated": "2019-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MO",
            "license": "2006025361",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "JONES",
            "middle_name": "COWART",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Springfield, MO

Sources for this page

Verify at the official NPI Registry.