David Frederick Widitz, MD

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

036166942 Issued in IL

Practice address

421 W Broadway Ste 302
Council Bluffs, IA 51503-9046

Phone

(319) 208-2744

Fax

(319) 208-2627

NPI assigned

Oct 30, 2007

Last updated

Feb 1, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in IA, IL2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Psychiatry

Education

Pennsylvania State University College of Medicine, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

ArrowleafGroup PAC ID 2567535123, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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

• Arrowleaf

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Golconda, IL
  • NPI 1538114608
  Medicare reassignment Care Compare group NPD
• Hillcrest Family Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Washington, IA
  • NPI 1023232824
  Medicare reassignment NPD
• Osf Multi-Specialty Group

  • Internal Medicine Physician
  • Peoria, IL
  • NPI 1922445527
  Medicare reassignment NPD
• Hillcrest Family Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Dubuque, IA
  • NPI 1497977763
  NPD
• Central PA Pharmacy LLC.

  dba patton pharmacy and v&s variety

  • Community/Retail Pharmacy
  • Patton, PA
  • NPI 1578541413
  NPD
• Gersh, Hartson, Payne & Associates, PC

  • Psychologist
  • Iowa City, IA
  • NPI 1558704957
  NPD (past)
• Prevention Systems, Inc.

  dba The Hauser Clinic

  • Psychiatry Physician
  • Coralville, IA
  • NPI 1366637936
  NPD (past)
• Arrowleaf

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Metropolis, IL
  • NPI 1982447975
  NPD (past)

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

{
    "created_epoch": "1193702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706745600000",
    "number": "1205015906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 W BROADWAY STE 302",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515039046",
            "telephone_number": "319-208-2744",
            "fax_number": "319-208-2627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 W BROADWAY STE 302",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515039046",
            "telephone_number": "319-208-2744",
            "fax_number": "319-208-2627"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "707 N Logan Ave",
            "address_purpose": "LOCATION",
            "city": "Danville",
            "state": "IL",
            "postal_code": "618324360",
            "country_code": "US",
            "telephone_number": "217-431-7117",
            "fax_number": "217-477-4754",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "101 Oliver St",
            "address_purpose": "LOCATION",
            "city": "Vienna",
            "state": "IL",
            "postal_code": "629951660",
            "country_code": "US",
            "telephone_number": "618-658-3079",
            "fax_number": "618-658-2759",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIDITZ",
        "first_name": "DAVID",
        "middle_name": "FREDERICK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-30",
        "last_updated": "2024-02-01",
        "certification_date": "2024-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036166942",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IA",
            "license": "37338",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "IA",
            "license": "37338",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "IL",
            "license": "036166942",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Whalen, M.D.
• Angela Wheeler
• Andrea Celeste White, ARNP
• Michelle White
• Kara A Widhalm, PA-C
• Lindsie Wilde I, PHARMD
• Anna Theresa Wiley, MD
• Devon Wilhelm-McMullen, DNP
• Kent Willadsen, M.D.
• Gilbert M. Willett, P.T., PH.D.

• Child & Adolescent Psychiatry Physician in Council Bluffs, IA
• Providers in Council Bluffs, IA by specialty
• Child & Adolescent Psychiatry Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2024; 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.