Active NPI
Gwen Hohman-Bultje, PHD
- Clinical Psychologist
- Clear Lake, IA
National Provider Identifier
1841307592
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 00866
- Practice address
- 9400 Wheelerwood Dr
Clear Lake, IA 50428-9167 - Phone
- (641) 420-0891
- Fax
- (641) 423-2893
- NPI assigned
- Aug 25, 2006
- Last updated
- Mar 4, 2019
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 00866 | IA | Primary |
Addresses
Primary practice location
9400 Wheelerwood Dr
Clear Lake, IA 50428-9167
Mailing address
9400 Wheelerwood Dr
Clear Lake, IA 50428-9167
Phone (641) 420-0891
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0232330 | Medicaid | IA | |
| 04822 | Other | IA | WELLMARK |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00866 | IA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Health Services-Iowa Corp | Past | Accepting new patients | |
| North Iowa Mercy Clinics | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba MercyOne Northwood Pharmacy
- Community/Retail Pharmacy
- Northwood, IA
- NPI 1316909484
-
dba MercyOne North Iowa Behavioral Services Center
- Cognitive & Behavioral Psychologist
- Mason City, IA
- NPI 1730197492
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156464000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1551657600000",
"number": "1841307592",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9400 WHEELERWOOD DR",
"city": "CLEAR LAKE",
"state": "IA",
"postal_code": "504289167",
"telephone_number": "641-420-0891",
"fax_number": "641-423-2893"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9400 WHEELERWOOD DR",
"city": "CLEAR LAKE",
"state": "IA",
"postal_code": "504289167",
"telephone_number": "641-420-0891",
"fax_number": "641-423-2893"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOHMAN-BULTJE",
"first_name": "GWEN",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-25",
"last_updated": "2019-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IA",
"license": "00866",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0232330",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLMARK",
"identifier": "04822",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clear Lake, IA
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- Duane A Hermen, PT
- Hilary Reynolds DDS PC (Clear Lake Pediatric Dentistry)
- Joshua D Hildebrand, DPT
- Todd Darwin Hocraffer, D.C.
- Stephen A Holbrook, PSYD
- Iarc CL, LLC (Apple Valley Place)
- Iinfusion Care LLC (iInfusion Care)
- Integrative Medicine Consultants, Inc.
- Brittney Jacobson, SLP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.