Matt Costley, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2010032191 Issued in MO

Practice address

2200 E Cleveland St
Monett, MO 65708-6149

Phone

(417) 236-2600

Fax

(417) 236-2619

NPI assigned

Aug 21, 2008

Last updated

Aug 8, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Clark Community Mental Health CenterGroup PAC ID 8527069277, 25 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Clark Community Mental Health Center

  • Community/Behavioral Health Agency
  • Monett, MO
  • NPI 1801807771
  Medicare reassignment Care Compare group
• College Skyline Center LLC

  • Clinic/Center
  • Joplin, MO
  • NPI 1598764110
  NPD (past)

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

{
    "created_epoch": "1219276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470614400000",
    "number": "1629225685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 E CLEVELAND ST",
            "city": "MONETT",
            "state": "MO",
            "postal_code": "657086149",
            "telephone_number": "417-236-2600",
            "fax_number": "417-236-2619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 E CLEVELAND ST",
            "city": "MONETT",
            "state": "MO",
            "postal_code": "657086149",
            "telephone_number": "417-236-2600",
            "fax_number": "417-236-2619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTLEY",
        "first_name": "MATT",
        "name_prefix": "Mr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-21",
        "last_updated": "2016-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MO",
            "license": "2010032191",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Theodore Frank Collier, CRNA
• Jennifer Eleanor Conner
• Kathleen Josef Cook, PT, DPT
• Nicole Coorts, PLPC
• Clifford M. Costley, M.D.
• Ainsley Katherine Cotherman, M.A. CCC-SLP
• Countryside Care Center, LLC
• Cox Monett Hospital Inc (Family and Occupational Medicine of Monett)
• Cox Monett Hospital Inc (CoxHealth Occupational Medicine Monett)
• Cox Monett Hospital Inc (Coxhealth Surgery Monett)

• Clinical Psychologist in Monett, MO
• Providers in Monett, MO by specialty
• Clinical Psychologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2016; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.