NPIMap

Individual provider Active NPI

Courtney Marie Camillus, PHD

  • Psychologist
  • Columbus, OH
National Provider Identifier
1669764122
Registry record updated May 3, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
6686 Issued in OH
Practice address
2000 Polaris Pkwy
Suite 100
Columbus, OH 43240-2108
Phone
(614) 430-9837
Fax
(614) 430-9697
NPI assigned
May 3, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 3, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 6686 OH Primary

Addresses

Primary practice location

2000 Polaris Pkwy
Suite 100
Columbus, OH 43240-2108

Mailing address

2000 Polaris Pkwy
Suite 100
Columbus, OH 43240-2108
Phone (614) 430-9837

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)
Enrolled
Credentials
Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Medpsych Ohio Valley , Inc Psychologist PastSince Mar 1, 2013 Accepting new patients

Organizations & group practices 1

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": "1304380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304380800000",
    "number": "1669764122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 POLARIS PKWY",
            "address_2": "SUITE 100",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432402108",
            "telephone_number": "614-430-9837",
            "fax_number": "614-430-9697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 POLARIS PKWY",
            "address_2": "SUITE 100",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432402108",
            "telephone_number": "614-430-9837",
            "fax_number": "614-430-9697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMILLUS",
        "first_name": "COURTNEY",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-03",
        "last_updated": "2011-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OH",
            "license": "6686",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2011; 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.