Individual provider Active NPI

Rachel Joy Wiseman, PH.D.

  • Clinical Neuropsychologist
  • Sarasota, FL
National Provider Identifier
1447425137
Registry record updated Apr 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
PY7703 Issued in FL
Practice address
3800 S Tamiami TRL Unit 210
Sarasota, FL 34239-6909
Phone
(941) 366-1693
Fax
(941) 922-7574
NPI assigned
Apr 24, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 24, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X PY7703 FL Primary

Addresses

Primary practice location

3800 S Tamiami TRL Unit 210
Sarasota, FL 34239-6909

Mailing address

3800 S Tamiami TRL Unit 210
Sarasota, FL 34239-6909
Phone (941) 366-1693

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20080909000700 FL Practitioner - Clinical Psychologist 0941376362 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
William H Pettibon PHD PAGroup PAC ID 7618025131, 4 clinicians

Practice addresses (Care Compare)

333 Tamiami S TRL
Suite 368
Venice, FL 34285-2442
Phone (941) 366-1693

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
William H Pettibon PHD PA CurrentSince Mar 3, 2009 Accepting new patients
William H Pettibon PHD Past Accepting new patients

Locations

3800 S Tamiami Trl
Unit 210
Sarasota, FL 34239
Phone (941) 366-1693

333 Tamiami Trl S
Ste 368
Venice, FL 34285
Phone (941) 366-1693

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1208995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208995200000",
    "number": "1447425137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3800 S TAMIAMI TRL UNIT 210",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342396909",
            "telephone_number": "941-366-1693",
            "fax_number": "941-922-7574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3800 S TAMIAMI TRL UNIT 210",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342396909",
            "telephone_number": "941-366-1693",
            "fax_number": "941-922-7574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISEMAN",
        "first_name": "RACHEL",
        "middle_name": "JOY",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-04-24",
        "last_updated": "2008-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "FL",
            "license": "PY7703",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sarasota, FL

Sources for this page

Verify at the official NPI Registry.