Active NPI
John R Boekamp, PHD
- Clinical Psychologist
- East Providence, RI
National Provider Identifier
1790722627
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PS00666
- Practice address
- 1011 Veterans Memorial Pkwy
East Providence, RI 02915-5061 - Phone
- (401) 432-1417
- Fax
- (401) 432-1500
- NPI assigned
- May 31, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PS00666 | RI | Primary |
Addresses
Primary practice location
1011 Veterans Memorial Pkwy
East Providence, RI 02915-5061
Mailing address
1011 Veterans Memorial Pkwy
East Providence, RI 02915-5061
Phone (401) 432-1284
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 407017 | Other | RI | BLUE CHIP |
| 61-77966 | Other | RI | UNITED BEHAVIORAL HEALTH |
| JB29480 | Medicaid | RI | |
| 30160-4 | Other | RI | BLUE CROSS |
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS00666 | RI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149033600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1294272000000",
"number": "1790722627",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1011 VETERANS MEMORIAL PKWY",
"city": "EAST PROVIDENCE",
"state": "RI",
"postal_code": "029155061",
"telephone_number": "401-432-1284",
"fax_number": "401-432-1509"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1011 VETERANS MEMORIAL PKWY",
"city": "EAST PROVIDENCE",
"state": "RI",
"postal_code": "029155061",
"telephone_number": "401-432-1417",
"fax_number": "401-432-1500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOEKAMP",
"first_name": "JOHN",
"middle_name": "R",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-31",
"last_updated": "2011-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "RI",
"license": "PS00666",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CHIP",
"identifier": "407017",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED BEHAVIORAL HEALTH",
"identifier": "61-77966",
"state": "RI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "JB29480",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "30160-4",
"state": "RI"
}
],
"endpoints": [],
"other_names": []
}Other providers in East Providence, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.