NPIMap

State of Missouri

Organization Active NPI Psychiatry Physician · Kansas City, MO

NPI 1497709083 · NPPES record last updated Oct 27, 2020

Key facts

NPI
1497709083
Entity type
Organization (NPI type 2)
Primary specialty
Psychiatry Physician 2084P0800X
Legal business name
STATE OF MISSOURI
Practice address
1000 E 24TH St
Kansas City, MO 64108-2776
Phone
(816) 512-7000
Fax
(816) 512-7509
NPI assigned
May 19, 2006
Organization subpart
Yes
Parent organization (as reported)
STATE OF MISSOURI

Authorized official

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

Owned or controlled facilities with NPI records 6

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs on the same Medicare enrollment 6

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

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Practitioners 65

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 65

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MO

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Center for Behavioral Medicine
Kansas City, MO · CCN 264008		 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1966
St Louis Forensic Treatment Center
Saint Louis, MO · CCN 264010		 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1966
Southeast Missouri Mental Health Center
Farmington, MO · CCN 264005		 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1966
Fulton State Hospital
Fulton, MO · CCN 264004		 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1966
Northwest Missouri Psychiatric Rehabilitation Center
Saint Joseph, MO · CCN 264007		 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 1966
Jan 1, 1966
Hawthorn Children'S Psychiatric Hospital
Saint Louis, MO · CCN 264028		 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1981

Medicare enrollment records

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
Practice locations: Kansas City, MO; Marshall, MO; Nevada, MO; Saint Joseph, MO; Higginsville, MO

National Provider Directory

Part of
Southwest Missouri Psy

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207R00000X
Psychiatry Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 2084P0800X Yes

Addresses

Primary practice location

1000 E 24TH St
Kansas City, MO 64108-2776

Mailing address

1706 E Elm St
Jefferson City, MO 65101-4130
Phone (573) 751-3398

Other identifiers

IdentifierTypeStateIssuer
500931704MedicaidMO

Other names

  • Center for Behavioral Health Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 27, 2020.

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603756800000",
    "number": "1497709083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1706 E ELM ST",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651014130",
            "telephone_number": "573-751-3398",
            "fax_number": "573-526-4560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 E 24TH ST",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641082776",
            "telephone_number": "816-512-7000",
            "fax_number": "816-512-7509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF MISSOURI",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATE OF MISSOURI",
        "enumeration_date": "2006-05-19",
        "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": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500931704",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Center for Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Center for Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kansas City, MO

All providers in Kansas City, MO · Psychiatry Physician in Missouri

Sources for this page

Verify at the official NPI Registry.