Active NPI
Benjamin Martin Wilson
- Marriage & Family Therapist
- Louisville, KY
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 248552
- Practice address
- 4010 Dupont Cir Ste 582
Louisville, KY 40207-4888 - Phone
- (502) 899-5411
- NPI assigned
- Sep 4, 2019
- Last updated
- Sep 4, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 248552 | KY | Primary |
Addresses
Primary practice location
4010 Dupont Cir Ste 582
Louisville, KY 40207-4888
Mailing address
17313 Curry Branch Rd
Louisville, KY 40245-7501
Phone (502) 930-5745
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Marriage and Family Therapist
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
214 Breckenridge LN
Suite 114
Louisville, KY 40207-3868
Phone (502) 653-7211
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 248552 | KY | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Renew Counseling, LLC | Current | Accepting new patients |
Locations
214 Breckenridge Ln
Ste 114
Louisville, KY 40207
Phone (502) 554-2439
802 Stone Creek Pkwy
Ste 1A
Louisville, KY 40223
Phone (502) 653-7211
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Renew Counseling Services
- Community/Behavioral Health Agency
- Louisville, KY
- NPI 1437699428
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1567555200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1567555200000",
"number": "1700434636",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17313 CURRY BRANCH RD",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402457501",
"telephone_number": "502-930-5745"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4010 DUPONT CIR STE 582",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402074888",
"telephone_number": "502-899-5411"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "BENJAMIN",
"middle_name": "MARTIN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-09-04",
"last_updated": "2019-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "KY",
"license": "248552",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2019; 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.