Active NPI
Roundtable Wellness
- Adult Mental Health Clinic/Center
- Carmel, IN
National Provider Identifier
1023739067
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Mental Health Clinic/Center
- Legal business name
- ROUNDTABLE WELLNESS
- Practice address
- 90 Executive Dr Ste C
Carmel, IN 46032-2612 - Phone
- (765) 630-7222
- Fax
- (765) 630-7905
- NPI assigned
- Sep 8, 2022
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Renee Michelle Tilt
- Title
- Owner, Ceo, Clinical Director
- Phone
- (765) 630-7222
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 6
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Clinical Social Worker | 1041C0700X | |||
| Registered Dietitian | 133V00000X | |||
| Adult Mental Health Clinic/Center | 261QM0850X | Primary | ||
| Adolescent and Children Mental Health Clinic/Center | 261QM0855X | |||
| Multi-Specialty Clinic/Center | 261QM1300X |
Addresses
Primary practice location
90 Executive Dr Ste C
Carmel, IN 46032-2612
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
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 LCC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Mental Health Counselor
- Lafayette, IN
- NPI 1013366251
Practitioners & affiliated clinicians
Practitioners 8
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Registered Dietitian
- Lafayette, IN
- NPI 1174672216
Dietitian, Registered
-
- Mental Health Counselor
- Lafayette, IN
- NPI 1134713308
-
- Anesthesiology Physician
- Lafayette, IN
- NPI 1891701751
-
- Mental Health Counselor
- Carmel, IN
- NPI 1629990973
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1662595200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1662595200000",
"number": "1023739067",
"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": "765-630-7905"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "90 EXECUTIVE DR STE C",
"city": "CARMEL",
"state": "IN",
"postal_code": "460322612",
"telephone_number": "765-630-7222",
"fax_number": "765-630-7905"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ROUNDTABLE WELLNESS",
"organizational_subpart": "NO",
"enumeration_date": "2022-09-08",
"last_updated": "2022-09-08",
"certification_date": "2022-09-08",
"status": "A",
"authorized_official_last_name": "TILT",
"authorized_official_first_name": "RENEE",
"authorized_official_middle_name": "MICHELLE",
"authorized_official_title_or_position": "OWNER, CEO, CLINICAL DIRECTOR",
"authorized_official_telephone_number": "765-630-7222"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": false
},
{
"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": true
},
{
"code": "261QM0855X",
"taxonomy_group": "",
"desc": "Clinic/Center, Adolescent and Children Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "261QM1300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Multi-Specialty",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Carmel, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2022; 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.