Active NPI
David Ellsworth Wilt, PH.D.
- Clinical Psychologist
- Knoxville, TN
National Provider Identifier
1841326766
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- P344
- Practice address
- 111 Westfield Road
Knoxville, TN 37919-4820 - Phone
- (865) 588-9572
- Fax
- (865) 584-6219
- NPI assigned
- Feb 26, 2007
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | P344 | TN | Primary |
Addresses
Primary practice location
111 Westfield Road
Knoxville, TN 37919-4820
Mailing address
111 Westfield Road
Knoxville, TN 37919-4820
Phone (865) 588-9572
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3689034 | Medicaid | TN | |
| 2008885 | Other | TN | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120209000195 | TN | Practitioner - Clinical Psychologist | 9234396896 | Practice locations: Knoxville, TN |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- University of Tennessee, HSC, College of Medicine, 1973
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
111 Westfield Rd
Knoxville, TN 37919-4820
Phone (865) 588-9572
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172448000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1841326766",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 WESTFIELD ROAD",
"city": "KNOXVILLE",
"state": "TN",
"postal_code": "379194820",
"telephone_number": "865-588-9572",
"fax_number": "865-584-6219"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 WESTFIELD ROAD",
"city": "KNOXVILLE",
"state": "TN",
"postal_code": "379194820",
"telephone_number": "865-588-9572",
"fax_number": "865-584-6219"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILT",
"first_name": "DAVID",
"middle_name": "ELLSWORTH",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TN",
"license": "P344",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3689034",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "2008885",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Knoxville, TN
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; 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.