Individual provider Active NPI

Carrie E Tully, PHD

  • Clinical Child & Adolescent Psychologist
  • Washington, DC
National Provider Identifier
1215292768
Registry record updated Oct 4, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
Practice address
111 Michigan Ave NW
Washington, DC 20010-2916
Phone
(202) 476-5000
NPI assigned
Jul 11, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent Psychologist 103TC2200X Primary

Addresses

Primary practice location

111 Michigan Ave NW
Washington, DC 20010-2916

Mailing address

PO Box 37215
Baltimore, MD 21297-3215
Phone (202) 476-5000

Other identifiers 1

IdentifierTypeStateIssuer
004945182MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
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
I20171113003150 DC Practitioner - Clinical Psychologist 0941566624 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Hospital CurrentSince Sep 10, 2017 Accepting new patients
Children'S Hospital Current Accepting new patients
Children'S Hospital CurrentSince Sep 10, 2017 Accepting new patients

Locations

111 Michigan Ave NW
Washington, DC 20010
Phone (202) 476-3670

Organizations & group practices 3

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": "1341964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1507075200000",
    "number": "1215292768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 37215",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212973215",
            "telephone_number": "202-476-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 MICHIGAN AVE NW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200102916",
            "telephone_number": "202-476-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TULLY",
        "first_name": "CARRIE",
        "middle_name": "E",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-11",
        "last_updated": "2017-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004945182",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, DC

Sources for this page

Verify at the official NPI Registry.