NPIMap

Organization Active NPI

Roundtable Wellness

  • Mental Health Counselor
  • Lafayette, IN
National Provider Identifier
1013366251
Registry record updated Dec 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
ROUNDTABLE WELLNESS
Practice address
904 South St
Lafayette, IN 47901-1416
Phone
(765) 630-7222
NPI assigned
Jun 8, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2024

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

Authorized official

Name
Renee M Tilt, RDN, CSP
Title
Owner & Registered Dietitian
Phone
(765) 630-7222

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary
Registered DietitianGroup: 193200000X MULTI-SPECIALTY GROUP 133V00000X
Adult Mental Health Clinic/Center 261QM0850X
Adolescent and Children Mental Health Clinic/Center 261QM0855X

Addresses

Primary practice location

904 South St
Lafayette, IN 47901-1416

Mailing address

904 South St
Lafayette, IN 47901-1416
Phone (765) 630-7222

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161111000627 IN Part B Supplier - Clinic/Group Practice 7810276060 Receives reassigned benefits from 1 practitioner
1 other NPI on this enrollment
Practice locations: Carmel, IN; Lafayette, IN

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Round Table Wellness LCC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

90 Executive Dr
Ste C
Carmel, IN 46032
Phone (317) 740-1970

220 S Elm St
Zionsville, IN 46077
Phone (317) 873-8140

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1465344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734912000000",
    "number": "1013366251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "904 SOUTH ST",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479011416",
            "telephone_number": "765-630-7222",
            "fax_number": "765-807-3210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "904 SOUTH ST",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479011416",
            "telephone_number": "765-630-7222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROUNDTABLE WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-08",
        "last_updated": "2024-12-23",
        "certification_date": "2024-12-23",
        "status": "A",
        "authorized_official_last_name": "TILT",
        "authorized_official_first_name": "RENEE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER & REGISTERED DIETITIAN",
        "authorized_official_telephone_number": "765-630-7222",
        "authorized_official_credential": "RDN, CSP"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.