Individual provider Active NPI

Bruce G Bender, PHD

  • Psychologist
  • Denver, CO
National Provider Identifier
1508875899
Registry record updated Feb 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
642 Issued in CO
Practice address
1400 Jackson St
Denver, CO 80206-2761
Phone
(303) 388-4461
Fax
(303) 398-1211
NPI assigned
Aug 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 642 CO Primary

Addresses

Primary practice location

1400 Jackson St
Denver, CO 80206-2761

Mailing address

1400 Jackson St
Denver, CO 80206-2761
Phone (303) 388-4461

Other identifiers 1

IdentifierTypeStateIssuer
572088727MedicaidCO

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address NJHealth@njc.allscriptsdirect.net

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)
Not enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
642COMDOccupational Therapist

NPI Registry JSON

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613692800000",
    "number": "1508875899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 JACKSON ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802062761",
            "telephone_number": "303-388-4461",
            "fax_number": "303-398-1211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 JACKSON ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802062761",
            "telephone_number": "303-388-4461",
            "fax_number": "303-398-1211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENDER",
        "first_name": "BRUCE",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2021-02-19",
        "certification_date": "2021-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CO",
            "license": "642",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "572088727",
            "state": "CO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "NJHealth@njc.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "1400 Jackson St",
            "city": "Denver",
            "state": "CO",
            "country_code": "US",
            "postal_code": "802062761",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Denver, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.