Individual provider Active NPI

Caryl Boehnert, PH.D.

  • Clinical Psychologist
  • Eureka, CA
National Provider Identifier
1780848515
Registry record updated Jul 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
LP4290 Issued in MN
Practice address
2412 Buhne St
Eureka, CA 95501-3207
Phone
(707) 441-1624
Fax
(707) 441-1253
NPI assigned
Jul 10, 2008
Last updated
Jul 10, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X LP4290 MN Primary

Addresses

Primary practice location

2412 Buhne St
Eureka, CA 95501-3207

Mailing address

670 9TH St
Suite 203
Arcata, CA 95521-6248
Phone (707) 826-8633

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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

Enrollment IDStateProvider typePAC IDDetails
I20040618001114 MN Practitioner - Clinical Psychologist 8224013818 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Healthwise Psychology PAGroup PAC ID 2567685647, 32 clinicians

Practice addresses (Care Compare)

18205 45TH Ave N
Plymouth, MN 55446-4551
Phone (763) 400-7828

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
LP4290MNMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Scott M Yarosh, LLC CurrentSince Mar 1, 2020 Accepting new patients
Healthwise Psychology, PA Clinical CurrentSince Mar 1, 2020 Accepting new patients
Bridge Medical Supply, Inc. Past Accepting new patients
University of Minnesota Physicians Past Accepting new patients
Open Door Community Health Centers Past Accepting new patients
University of Minnesota Physicians Past Accepting new patients

Locations

11280 86th Ave N
Maple Grove, MN 55369
Phone (763) 400-7828

18205 45th Ave N
Plymouth, MN 55446
Phone (763) 400-7828

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1215648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1215648000000",
    "number": "1780848515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "670 9TH ST",
            "address_2": "SUITE 203",
            "city": "ARCATA",
            "state": "CA",
            "postal_code": "955216248",
            "telephone_number": "707-826-8633",
            "fax_number": "707-826-8638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2412 BUHNE ST",
            "city": "EUREKA",
            "state": "CA",
            "postal_code": "955013207",
            "telephone_number": "707-441-1624",
            "fax_number": "707-441-1253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOEHNERT",
        "first_name": "CARYL",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-10",
        "last_updated": "2008-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP4290",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eureka, CA

Sources for this page

Verify at the official NPI Registry.