Emmaline Weidman, PH.D

Primary specialty

PsychologistTaxonomy code 103T00000X

License

6301005683 Issued in MI

Practice address

18611 Clipperview Rd
Charlevoix, MI 49720-9711

Phone

(231) 547-7323

Fax

(231) 547-7327

NPI assigned

Jul 21, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 10

Medicare fee-for-service enrollment

Enrolled in MI

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

Specialty

Clinical Psychologist

Education

Other, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317686400000",
    "number": "1093736845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18611 CLIPPERVIEW RD",
            "city": "CHARLEVOIX",
            "state": "MI",
            "postal_code": "497209711",
            "telephone_number": "231-547-7323",
            "fax_number": "231-547-7327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18611 CLIPPERVIEW RD",
            "city": "CHARLEVOIX",
            "state": "MI",
            "postal_code": "497209711",
            "telephone_number": "231-547-7323",
            "fax_number": "231-547-7327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEIDMAN",
        "first_name": "EMMALINE",
        "name_prefix": "Dr.",
        "credential": "PH.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-21",
        "last_updated": "2011-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301005683",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5585230",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD",
            "identifier": "62OF34852",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "U.S. BEHAVIORAL HEALTH",
            "identifier": "55410-72564",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA BEHAVIORAL HEALTH",
            "identifier": "1055752",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "046482",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARE CHOICE",
            "identifier": "140447",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHN",
            "identifier": "207174",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PPOM",
            "identifier": "58894",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN",
            "identifier": "I.P.046056",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMPSYCH",
            "identifier": "136230",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexandra Bokor Waha, LMSW
• Walgreen Co
• Ernest Walker, PA-C
• Lisa Ward, LICENSED PTA
• Brandon Weaver, D.C.
• Andrew John Weise, M.D.
• Casey Thomas Weitzel, PA-C
• Rebecca A Weldon, OTR
• Tory Werth, CADC
• Veronica Jean Wetzel

• Psychologist in Charlevoix, MI
• Providers in Charlevoix, MI by specialty
• Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.