Individual provider Active NPI

Colin M Bosma, PHD

  • Clinical Psychologist
  • Newberg, OR
National Provider Identifier
1851060446
Registry record updated Apr 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
3548 Issued in OR
Practice address
1000 N Providence Dr Ste 120
Newberg, OR 97132-7582
Phone
(503) 537-5900
NPI assigned
Sep 8, 2021
Last updated
Apr 21, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2023

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 3548 OR Primary

Addresses

Primary practice location

1000 N Providence Dr Ste 120
Newberg, OR 97132-7582

Mailing address

PO Box 3158
Portland, OR 97208-3158
Phone (503) 215-6494

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20221026001700 OR Practitioner - Clinical Psychologist 4183090533 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1000 N Providence Dr
Suite 120
Newberg, OR 97132-7582
Phone (503) 537-5900

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3548ORMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Oregon Current Accepting new patients
Providence Health & Services - Oregon CurrentSince Oct 1, 2022 Accepting new patients
Providence Health & Services Oregon CurrentSince Oct 1, 2022 Accepting new patients

Locations

1000 N Providence Dr
Ste 120
Newberg, OR 97132
Phone (503) 537-5700

1001 N Providence Dr
Newberg, OR 97132
Phone (503) 216-1538

1003 N Providence Dr
Ste 325
Newberg, OR 97132
Phone (503) 216-1661

Organizations & group practices 3

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": "1631059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682035200000",
    "number": "1851060446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158",
            "telephone_number": "503-215-6494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 N PROVIDENCE DR STE 120",
            "city": "NEWBERG",
            "state": "OR",
            "postal_code": "971327582",
            "telephone_number": "503-537-5900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOSMA",
        "first_name": "COLIN",
        "middle_name": "M",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-09-08",
        "last_updated": "2023-04-21",
        "certification_date": "2023-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "3548",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newberg, OR

Sources for this page

Verify at the official NPI Registry.