Individual provider Active NPI

Robert D. Wells, PH.D.

  • Psychologist
  • Crestview Hills, KY
National Provider Identifier
1073611554
Registry record updated Apr 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
129179 Issued in KY
Practice address
334 Thomas More Parkway
Crestview Hills, KY 41017-3464
Phone
(859) 301-5901
Fax
(859) 301-5940
NPI assigned
Sep 20, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 10, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 1433 KY
Counseling Psychologist 103TC1900X 1433 KY
Psychologist 103T00000X 129179 KY Primary

Addresses

Primary practice location

334 Thomas More Parkway
Crestview Hills, KY 41017-3464

Mailing address

PO Box 635283
Cincinnati, OH 45263-5283
Phone (859) 301-5901

Other identifiers 2

IdentifierTypeStateIssuer
0154652MedicaidOH
7100403940MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080515000419 KY Practitioner - Clinical Psychologist 4688743701 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Texas a & M University System, HSC, College of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Summit Medical Group IncGroup PAC ID 2163326240, 803 clinicians

Practice addresses (Care Compare)

7388 Turfway Rd
Florence, KY 41042-1381
Phone (859) 578-5880

Merit-based Incentive Payment System (MIPS)

Final score
93.01 of 100Reported as apm
Quality
86.02
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
1433KYMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Medical Group, Inc Psychologist CurrentSince Mar 1, 2016 Accepting new patients
Summit Medical Group, Inc. CurrentSince Mar 1, 2016 Accepting new patients

Locations

334 Thomas More Pkwy
Crestview Hills, KY 41017
Phone (859) 331-6065

7388 Turfway Rd
Florence, KY 41042
Phone (606) 331-9000

1980 Litton Ln
Hebron, KY 41048
Phone (859) 334-8700

300 Barnes Rd
Williamstown, KY 41097
Phone (859) 824-8217

Interoperability endpoints

  • Direct secure messaging: rwells188477@direct-prd.stelizabeth.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554854400000",
    "number": "1073611554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 635283",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452635283",
            "telephone_number": "859-301-5901",
            "fax_number": "859-301-5940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "334 THOMAS MORE PARKWAY",
            "city": "CRESTVIEW HILLS",
            "state": "KY",
            "postal_code": "410173464",
            "telephone_number": "859-301-5901",
            "fax_number": "859-301-5940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WELLS",
        "first_name": "ROBERT",
        "middle_name": "D.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2019-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "KY",
            "license": "1433",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "KY",
            "license": "1433",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "KY",
            "license": "129179",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0154652",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100403940",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crestview Hills, KY

Sources for this page

Verify at the official NPI Registry.