Jeremy Todd Bidwell, PH.D.

Primary specialty

Prescribing (Medical) PsychologistTaxonomy code 103TP0016X

License

074.000011 Issued in IL

Practice address

111 Dean St
Woodstock, IL 60098-3220

Phone

(815) 344-5061

Fax

(815) 344-5072

NPI assigned

Feb 1, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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

Specialty

Clinical Psychologist

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Lodestone Center for Behavioral Health PCGroup PAC ID 6709128317, 27 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• The Lodestone Center for Behavioral Health, PC

  • Psychologist
  • Woodstock, IL
  • NPI 1619448222
  Medicare reassignment Care Compare group Authorized official
• Center for Rural Psychology

  • Voluntary or Charitable Agency
  • Elburn, IL
  • NPI 1356451009
  NPD (past)
• Foroutan & Associates SC

  • Psychiatry Physician
  • Sycamore, IL
  • NPI 1063445476
  NPD (past)

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

{
    "created_epoch": "1264982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639526400000",
    "number": "1609108703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 DEAN ST",
            "city": "WOODSTOCK",
            "state": "IL",
            "postal_code": "600983220",
            "telephone_number": "815-344-5061",
            "fax_number": "815-344-5072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 DEAN ST",
            "city": "WOODSTOCK",
            "state": "IL",
            "postal_code": "600983220",
            "telephone_number": "815-344-5061",
            "fax_number": "815-344-5072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BIDWELL",
        "first_name": "JEREMY",
        "middle_name": "TODD",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-02-01",
        "last_updated": "2021-12-15",
        "certification_date": "2021-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071.007831",
            "primary": false
        },
        {
            "code": "103TP0016X",
            "taxonomy_group": "",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": "IL",
            "license": "074.000011",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Edwin Talcott Bennett, MSW-LCSW
• Rachelle Bentsen
• Rey Anthony Bernardo
• Better Living Institute
• Maria Nicole Bicouvaris, SLP
• Big Little Minds Counseling and Wellness PLLC
• Nicole Bimmerle, PHARMD
• Brian Benjamin Blackmon, DO
• Iwona Bobela, M.D.
• Ross Frank Bohl, DMD

• Prescribing (Medical) Psychologist in Woodstock, IL
• Providers in Woodstock, IL by specialty
• Prescribing (Medical) Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.