Individual provider Active NPI

Wayne Barry Wermuth, MED

  • Psychologist
  • Allentown, PA
National Provider Identifier
1053481150
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PS-001275-L Issued in PA
Practice address
1145 Clearwood Dr
Allentown, PA 18103-5405
Phone
(610) 821-8866
Fax
(610) 366-1960
NPI assigned
Nov 8, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PS-001275-L PA Primary
Psychologist 103T00000X PF-00106-L PA

Addresses

Primary practice location

1145 Clearwood Dr
Allentown, PA 18103-5405

Mailing address

1145 Clearwood Dr
Allentown, PA 18103-5405
Phone (610) 821-8866

Other identifiers 1

IdentifierTypeStateIssuer
03101301OtherPACAPITAL ADVANTAGE INS. CO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Education

State licenses

LicenseStateTypeSpecialty
PF-00106-LPAMDPsychologist
PS-001275-LPAMDPsychologist

NPI Registry JSON

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1053481150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1145 CLEARWOOD DR",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181035405",
            "telephone_number": "610-821-8866",
            "fax_number": "610-366-1960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1145 CLEARWOOD DR",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181035405",
            "telephone_number": "610-821-8866",
            "fax_number": "610-366-1960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WERMUTH",
        "first_name": "WAYNE",
        "middle_name": "BARRY",
        "name_prefix": "Mr.",
        "credential": "MED",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PS-001275-L",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PF-00106-L",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITAL ADVANTAGE INS. CO",
            "identifier": "03101301",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Allentown, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.