Individual provider Active NPI

Janice Vidic, PH.D.

  • Clinical Psychologist
  • Columbus, OH
National Provider Identifier
1417363805
Registry record updated Jan 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
7081 Issued in OH
Practice address
2200 W Broad St
Columbus, OH 43223-1297
Phone
(614) 752-0333
NPI assigned
Jul 7, 2014
Last updated
Jan 15, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 7081 OH Primary

Addresses

Primary practice location

2200 W Broad St
Columbus, OH 43223-1297

Mailing address

3971 Hoover Rd
#75
Grove City, OH 43123-2839
Phone (614) 517-4586

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20150204001473 OH Practitioner - Clinical Psychologist 8729303250 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

930 S Detroit Ave
Toledo, OH 43614-2701
Phone (419) 381-1881

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
7081OHMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
State of Ohio Office of Budget and Management State Accounting Current Accepting new patients
State of Ohio Office of Budget and Management State Accounting CurrentSince Mar 31, 2023 Accepting new patients

Locations

2200 W Broad St
Columbus, OH 43223

30 E Broad St
Fl 11
Columbus, OH 43215
Phone (614) 466-9930

930 S Detroit Ave
Toledo, OH 43614
Phone (419) 381-1881

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": "1404691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421280000000",
    "number": "1417363805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3971 HOOVER RD",
            "address_2": "#75",
            "city": "GROVE CITY",
            "state": "OH",
            "postal_code": "431232839",
            "telephone_number": "614-517-4586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 W BROAD ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432231297",
            "telephone_number": "614-752-0333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIDIC",
        "first_name": "JANICE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-07",
        "last_updated": "2015-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OH",
            "license": "7081",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

Verify at the official NPI Registry.