Jonathan Dale Rosenboom, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

01221 Issued in MO

Practice address

17571 N Dam Access Rd
Warsaw, MO 65355

Phone

(888) 403-1071

NPI assigned

Apr 17, 2009

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

Other identifiers 1

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, 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Compass Health IncGroup PAC ID 1951206754, 317 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Compass Health, Inc

  • Community/Behavioral Health Agency
  • Clinton, MO
  • NPI 1285619494
  Medicare reassignment Care Compare group NPD
• Compass Health, Inc

  • Federally Qualified Health Center (FQHC)
  • Rolla, MO
  • NPI 1558258632
  NPD

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

{
    "created_epoch": "1239926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584489600000",
    "number": "1679716864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 COMMUNITY",
            "city": "CLINTON",
            "state": "MO",
            "postal_code": "647358804",
            "telephone_number": "660-885-8131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17571 N DAM ACCESS RD",
            "city": "WARSAW",
            "state": "MO",
            "postal_code": "65355",
            "telephone_number": "888-403-1071"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1901 N Westwood Blvd",
            "address_2": "Suite 5",
            "address_purpose": "LOCATION",
            "city": "Poplar Bluff",
            "state": "MO",
            "postal_code": "639012800",
            "country_code": "US",
            "telephone_number": "573-680-6509",
            "fax_number": "573-760-0201",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1901 N Westwood Blvd",
            "address_2": "Suite 5",
            "address_purpose": "LOCATION",
            "city": "Poplar Bluff",
            "state": "MO",
            "postal_code": "639012800",
            "country_code": "US",
            "telephone_number": "573-680-6509",
            "fax_number": "573-760-0201",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "616 Burkarth Rd",
            "address_purpose": "LOCATION",
            "city": "Warrensburg",
            "state": "MO",
            "postal_code": "640931462",
            "country_code": "US",
            "telephone_number": "888-403-1071",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROSENBOOM",
        "first_name": "JONATHAN",
        "middle_name": "DALE",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-17",
        "last_updated": "2020-03-18",
        "certification_date": "2020-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MO",
            "license": "01221",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MISSOURI OFFICE OF ADMINISTRATION",
            "identifier": "0076557",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Tami Anne Rembolt, LCSW
• Robert Rensch
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• Leah Marie Rogers, PA-C
• Megan Rowland, NP
• Samuel and Jill Hieronymus
• Sedalia Eye Associates, P. C.
• Keith Edward Segall, DO
• Show Me Physical Therapy LLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2020; 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.