Meryl G Willert, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

287 Issued in ND

Practice address

300 45TH St SW
Suite 311
Fargo, ND 58103-1189

Phone

(701) 837-6508

Fax

(701) 858-1839

NPI assigned

Jan 23, 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

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in ND

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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 and National Provider Directory roles.

• Dakota Family Services

  • Clinic/Center
  • Minot, ND
  • NPI 1114119989
  Medicare reassignment NPD
• Dakota Family Services, Inc

  • Mental Health Counselor
  • Fargo, ND
  • NPI 1902940182
  NPD (past)
• Knowlton, O'Neill & Associates, P.C.

  • Psychologist
  • West Fargo, ND
  • NPI 1538198759
  NPD (past)
• Prairie St Johns

  • Psychiatric Hospital
  • Fargo, ND
  • NPI 1417901000
  NPD (past)
• PSJ Acquisition LLC

  • Psychiatric Hospital
  • Fargo, ND
  • NPI 1679709802
  NPD (past)

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

{
    "created_epoch": "1137974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1187654400000",
    "number": "1346210499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1148",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587021148",
            "telephone_number": "701-837-6508",
            "fax_number": "701-858-1839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 45TH ST SW",
            "address_2": "SUITE 311",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581031189",
            "telephone_number": "701-837-6508",
            "fax_number": "701-858-1839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLERT",
        "first_name": "MERYL",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-23",
        "last_updated": "2007-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "ND",
            "license": "287",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "18694",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS - FARGO",
            "identifier": "28565",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS - MINOT",
            "identifier": "28552",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS - BISMARCK",
            "identifier": "58569",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "20281773958103A002",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA (UBH)",
            "identifier": "61-28263",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelsey Wilker
• Lawrence Charles Wilkerson IV, DO
• Christy R Wilkie, LICSW
• Megan Willard, ATC
• Alisa Renay Willcox
• William C Porter MD LTD
• William Yvorchuk MDCM
• Darlingston H Williams Jr Jr.
• Amanda Williams, LSW
• Amanda Marie Williams, SPEECH LANGUAGE PATH

• Clinical Psychologist in Fargo, ND
• Providers in Fargo, ND by specialty
• Clinical Psychologist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.