Richard Lynn Brewer, PSY.D.
Individual provider Active NPI Psychologist · Bolivar, MO
NPI 1962472670 · NPPES record last updated Sep 17, 2015
Key facts
- NPI
- 1962472670
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 01577 (MO)
- Practice address
- 315 S Main Ave
Bolivar, MO 65613-2052 - Phone
- (417) 326-2902
- Fax
- (417) 326-4555
- NPI assigned
- Jan 25, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Psychiatry
- Education
- Other, 1991
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Clark Community Mental Health Center
Practice addresses (Care Compare)
1701 N Central Ave
Monett, MO 65708-1144
Phone (417) 235-6610
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150928001740 | MO | Practitioner - Psychiatry | 1052445293 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01577 | MO | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clark Community Mental Health Center | Current |
Accepting new patients |
Locations
1701 N Central Ave
Monett, MO 65708
Phone (417) 235-6610
104 W Main St
Pierce City, MO 65723
Phone (417) 235-6610
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 01577 | MO | Yes |
Addresses
Primary practice location
315 S Main Ave
Bolivar, MO 65613-2052
Mailing address
PO Box 100
Pierce City, MO 65723-2100
Phone (417) 476-1013
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2970 | Other | MO | BLUE CROSS BLUE SHIELD |
| 496642505 | Medicaid | MO |
Other providers in Bolivar, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 17, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.