Active NPI
John Martin Tidd, PSY.D.
- Clinical Psychologist
- Cincinnati, OH
National Provider Identifier
1780808741
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 4311
- Practice address
- 11497 Springfield Pike
Cincinnati, OH 45246-3551 - Phone
- (513) 772-9300
- Fax
- (513) 772-9302
- NPI assigned
- Apr 12, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 4311 | OH | Primary |
| Clinical Psychologist | 103TC0700X | 694 | KY |
Addresses
Primary practice location
11497 Springfield Pike
Cincinnati, OH 45246-3551
Mailing address
11497 Springfield Pike
Cincinnati, OH 45246-3551
Phone (513) 772-9300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0976583 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 1, 2015 through Apr 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4311 | OH | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Success Consortium Inc | Clinical | Past | Accepting new patients |
| Family Success Consortium Inc | Past | Accepting new patients |
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.
-
- Psychologist
- Cincinnati, OH
- NPI 1942520648
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176336000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1780808741",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11497 SPRINGFIELD PIKE",
"city": "CINCINNATI",
"state": "OH",
"postal_code": "452463551",
"telephone_number": "513-772-9300",
"fax_number": "513-772-9302"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11497 SPRINGFIELD PIKE",
"city": "CINCINNATI",
"state": "OH",
"postal_code": "452463551",
"telephone_number": "513-772-9300",
"fax_number": "513-772-9302"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIDD",
"first_name": "JOHN",
"middle_name": "MARTIN",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OH",
"license": "4311",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "KY",
"license": "694",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0976583",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cincinnati, OH
Sources for this page
- 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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.