Active NPI
James Wiltz, PHD
- Clinical Psychologist
- Bloomington, IN
National Provider Identifier
1356654693
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 20042253A
- Practice address
- 2745 E Elderberry CT
Bloomington, IN 47401-4307 - Phone
- (812) 679-7844
- NPI assigned
- Jul 15, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 20042253A | IN | Primary |
Addresses
Primary practice location
2745 E Elderberry CT
Bloomington, IN 47401-4307
Mailing address
2745 E Elderberry CT
Bloomington, IN 47401-4307
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200981790A | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20042253A | IN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1279152000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1279152000000",
"number": "1356654693",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2745 E ELDERBERRY CT",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474014307"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2745 E ELDERBERRY CT",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474014307",
"telephone_number": "812-679-7844"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILTZ",
"first_name": "JAMES",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-07-15",
"last_updated": "2010-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IN",
"license": "20042253A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200981790A",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.