State of Missouri
NPI 1164477873 · Psychiatry Physician · Fulton, MO
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
State of Missouri is a Psychiatry Physician organization in Fulton, MO (NPI 1164477873).
Provider details
- NPI number
- 1164477873
- Entity type
- Organization
- Primary specialty
- Psychiatry PhysicianAllopathic & Osteopathic Physicians
- Parent organization
- State of Missouri
- Organization subpart
- Yes
- Authorized official
- Molly Boeckmann, Director of Administrative Services(573) 751-4055
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Psychologist103T00000X
Behavioral Health & Social Service Providers
- Clinical Psychologist103TC0700X
Behavioral Health & Social Service Providers
- Clinical Social Worker1041C0700X
Behavioral Health & Social Service Providers
- Optometrist152W00000X
Eye and Vision Services Providers
- Family Medicine Physician207Q00000X
Allopathic & Osteopathic Physicians
- Internal Medicine Physician207R00000X
Allopathic & Osteopathic Physicians
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
20 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Other names (DBA / former)
- Doing business as
- Fulton State Hospital
- Doing business as
- Fulton State Hospital
Registry dates
- Enumerated
- 2006-05-23
- Last updated
- 2020-08-28
- Certified
- 2020-08-28
Frequently asked questions
- What is State of Missouri's NPI number?
- State of Missouri's National Provider Identifier (NPI) is 1164477873, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is State of Missouri?
- State of Missouri is classified in the NPPES registry as Psychiatry Physician (Allopathic & Osteopathic Physicians).
- Where is State of Missouri located?
- State of Missouri's practice location on file with NPPES is 600 E 5th St, Fulton, MO 65251-1753.
- What is State of Missouri's phone number?
- The practice phone number listed in the NPPES registry for State of Missouri is (573) 592-4100.
- Does State of Missouri accept Medicare?
- State of Missouri is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for State of Missouri?
- The authorized official listed on State of Missouri's NPPES record is Molly Boeckmann, Director of Administrative Services. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is State of Missouri's NPI active?
- Yes — State of Missouri's NPI (1164477873) is active in the NPPES registry as of the last update on 2020-08-28.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.