David Formwalt, PSY D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1104 Issued in AL

Practice address

7305 Cottage Hill Road
Mobile, AL 36695

Phone

(251) 776-1217

Fax

(251) 776-1219

NPI assigned

Nov 7, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AL, TX2 enrollments

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 2

Specialty

Clinical Psychologist

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/148f5931-d9cf-4d65-8c66-7021ed161b73/

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.

• David Formwalt, Psy.D., LLC

  • Psychologist
  • Mobile, AL
  • NPI 1316113970
  Medicare reassignment Authorized official
• Poarch Band of Creek Indians

  • Federally Qualified Health Center (FQHC)
  • Atmore, AL
  • NPI 1902916489

  TX

  Medicare reassignment NPD
• Formwalt and Williams Inc

  • Clinical Psychologist
  • Mobile, AL
  • NPI 1043304835
  NPD (past)

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1164591541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "POB 91276",
            "address_2": "DAVID FORMWALT PSY D LLC",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "36691",
            "telephone_number": "251-776-1217",
            "fax_number": "251-776-1219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7305 COTTAGE HILL ROAD",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "36695",
            "telephone_number": "251-776-1217",
            "fax_number": "251-776-1219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORMWALT",
        "first_name": "DAVID",
        "credential": "PSY D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-07",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "AL",
            "license": "1104",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard Charles Fordham, PHARMD
• Brenda Ruth Fore, LPC-S
• Forefront Dermatology, S.C.
• Formwalt and Williams Inc
• Annie L Formwalt, PSY.D.
• Nicole R. Formwalt, LPC
• David Zeke Forrister
• Andie Fort
• Matt V Fortner, LPC
• Brayan Fortunato

• Clinical Psychologist in Mobile, AL
• Providers in Mobile, AL by specialty
• Clinical Psychologist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.