Individual provider Active NPI

Jerome Timothy Viltz

  • Mental Health Counselor
  • Clarksville, TN
National Provider Identifier
1235267386
Registry record updated Apr 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
511 8TH St
Clarksville, TN 37040-3093
Phone
(931) 920-7263
Fax
(931) 920-7202
NPI assigned
Mar 1, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 17, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 6865 TN
Research Study Specialist 1744R1102X
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

511 8TH St
Clarksville, TN 37040-3093

Mailing address

1014 Christopher LN
Ashland City, TN 37015-2823
Phone (615) 792-2836

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20190620003123 TN Practitioner - Clinical Social Worker 8729312095 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Centerstone of Tennessee, Inc.Group PAC ID 9739088113, 114 clinicians

Practice addresses (Care Compare)

511 8TH St
Clarksville, TN 37040-3093
Phone (888) 291-4357

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6865TNMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Centerstone of Tennessee, Inc. CurrentSince Apr 8, 2019 Accepting new patients
Centerstone of Tennessee, Inc. CurrentSince Apr 8, 2019 Accepting new patients

Locations

511 8th St
Clarksville, TN 37040
Phone (615) 595-8383

1921 Ransom Pl
Nashville, TN 37217
Phone (615) 279-6700

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555459200000",
    "number": "1235267386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1014 CHRISTOPHER LN",
            "city": "ASHLAND CITY",
            "state": "TN",
            "postal_code": "370152823",
            "telephone_number": "615-792-2836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 8TH ST",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370403093",
            "telephone_number": "931-920-7263",
            "fax_number": "931-920-7202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VILTZ",
        "first_name": "JEROME",
        "middle_name": "TIMOTHY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-01",
        "last_updated": "2019-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "TN",
            "license": "6865",
            "primary": false
        },
        {
            "code": "1744R1102X",
            "taxonomy_group": "",
            "desc": "Specialist, Research Study",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarksville, TN

Sources for this page

Verify at the official NPI Registry.