John Richard Spooner, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2006034106 Issued in MO

Practice address

2085 S Boston PL
Bolivar, MO 65613-2871

Phone

(417) 326-2418

Fax

(417) 326-2419

NPI assigned

Jan 25, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

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, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

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.

• Good-Nous Family Counseling Center, LLC

  • Clinical Psychologist
  • Bolivar, MO
  • NPI 1447590104

  MO

  Medicare reassignment Authorized official
• Counseling Associates of the Four States, LLC

  • Mental Health Counselor
  • Joplin, MO
  • NPI 1023255106

  MO, Professional

  Medicare reassignment NPD

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

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379462400000",
    "number": "1750351409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2085 S BOSTON PL",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656132871",
            "telephone_number": "417-326-2418",
            "fax_number": "417-326-2419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2085 S BOSTON PL",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656132871",
            "telephone_number": "417-326-2418",
            "fax_number": "417-326-2419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPOONER",
        "first_name": "JOHN",
        "middle_name": "RICHARD",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-25",
        "last_updated": "2013-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MO",
            "license": "2002023735",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MO",
            "license": "2006034106",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "495966319",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "193564",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southern Light Residential
• Southwest Ozark Optometric Physicians Inc
• Sparks Pharmacy Inc
• Sparks Pharmacy Inc
• Jeff Sparks
• Cassie Stephans, PT
• Stephens Pharmacy Inc
• Stephens Pharmacy Inc
• Steven Bartholomew OD LLC
• Katelynn Stewart, LAT, ATC

• All providers in Bolivar, MO
• Clinical Psychologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2013; 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.