Robert Dombey Wadsworth, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

0810001262 Issued in VA

Practice address

10109 Krause Rd
Suite 100
Chesterfield, VA 23832-6501

Phone

(804) 751-8644

Fax

(804) 751-0648

NPI assigned

Jul 27, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 15

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Interoperability endpoints

• FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.72142

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.

• Three Rivers Treatment Center LLC

  dba Three Rivers Treatment Center

  • Psychiatric Residential Treatment Facility
  • Kenbridge, VA
  • NPI 1568827780
  NPD (past)
• Virginia South Psychiatric & Family Services

  • Psychiatry Physician
  • Petersburg, VA
  • NPI 1700894466
  NPD (past)

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1356355416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10109 KRAUSE RD",
            "address_2": "SUITE 100",
            "city": "CHESTERFIELD",
            "state": "VA",
            "postal_code": "238326501",
            "telephone_number": "804-751-8644",
            "fax_number": "804-751-0648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10109 KRAUSE RD",
            "address_2": "SUITE 100",
            "city": "CHESTERFIELD",
            "state": "VA",
            "postal_code": "238326501",
            "telephone_number": "804-751-8644",
            "fax_number": "804-751-0648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADSWORTH",
        "first_name": "ROBERT",
        "middle_name": "DOMBEY",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810001262",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UBH",
            "identifier": "61-72773",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VIRGINIA PREMIER",
            "identifier": "7747811",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APS",
            "identifier": "PVPB109775",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0004397887",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMPSYCH EAP",
            "identifier": "243328",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "085880",
            "identifier": "SENTARA",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "093091",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHN",
            "identifier": "241074",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VMC",
            "identifier": "008003",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P1567846",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUEOPTIONS",
            "identifier": "021955",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI",
            "identifier": "220674",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMPSYCH MH",
            "identifier": "243331",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM - GROUP",
            "identifier": "258978",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH",
            "identifier": "702275",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Victory Family Solutions LLC
• Village Counseling Services, LLC
• Virginia CVS Pharmacy, L.L.C. (CVS Pharmacy #01547)
• Vitalcare Family LLC (VitalCare Family Practice)
• Voices, LLC
• Waiver Services, LLC
• Wal-Mart Stores East LP (Walmart Pharmacy 10-4476)
• Walgreen Co (Walgreens #13126)
• Lisa Walker, RN
• Selwyn A Walker Sr.

• Clinical Psychologist in Chesterfield, VA
• Providers in Chesterfield, VA by specialty
• Clinical Psychologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.