Raymond R Tesauro, ED.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

P0000001934 Issued in TN

Practice address

107 Holland St
Shelbyville, TN 37160-3927

Phone

(931) 680-4370

Fax

(931) 680-4370

NPI assigned

Jul 11, 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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Psychopharmacology Associates, Inc.

  • Clinical Psychologist
  • Shelbyville, TN
  • NPI 1417988965
  NPD (past)
• Stellar Inc

  • Clinical Psychologist
  • Shelbyville, TN
  • NPI 1346278934
  NPD (past)

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1457386450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 743",
            "city": "LEBANON",
            "state": "TN",
            "postal_code": "370880743",
            "telephone_number": "931-680-4370",
            "fax_number": "931-680-4370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 HOLLAND ST",
            "city": "SHELBYVILLE",
            "state": "TN",
            "postal_code": "371603927",
            "telephone_number": "931-680-4370",
            "fax_number": "931-680-4370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TESAURO",
        "first_name": "RAYMOND",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "ED.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TN",
            "license": "P0000001934",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3687153",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3687158",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tennessee Homecare Alliance LLC
• Tennessee Oncology Pharmacy Dispensing
• Tennessee Oncology PLLC
• Tennessee Pain Management and Rehabilitation PC
• Terra Nova Health
• The Waters of Shelbyville LLC
• Thomas J. Nedumthottathil, MD
• Jennifer Leigh Thomas, PT, DPT
• Donna Lynette Thompson, FNP-BC
• Tia Danielle Thompson, PTA

• Clinical Psychologist in Shelbyville, TN
• Providers in Shelbyville, TN by specialty
• Clinical Psychologist in Tennessee

• 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.