Active NPI
Cassaundra Tennille Wimes, PHD
- Psychologist
- Miramar, FL
National Provider Identifier
1841483062
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PY 8192
- Practice address
- 7451 Riviera Blvd Ste 120
Miramar, FL 33023-6569 - Phone
- (305) 918-2588
- Fax
- (305) 974-1360
- NPI assigned
- Aug 21, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PY 8192 | FL | Primary |
Addresses
Primary practice location
7451 Riviera Blvd Ste 120
Miramar, FL 33023-6569
Mailing address
7451 Riviera Blvd Ste 120
Miramar, FL 33023-6569
Phone (305) 918-2588
Other practice location 1
111 NW 183rd St
Suite 423
Miami, FL 33169-4537
Phone (305) 918-2588
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 013070800 | Medicaid | FL | |
| 003127500 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- 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 |
|---|---|---|---|---|
| I20130715000359 | FL | Practitioner - Clinical Psychologist | 9436399185 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY 8192 | FL | MD | Psychologist |
Networks
- Freedom Health HMO Network
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187654400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1670889600000",
"number": "1841483062",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7451 RIVIERA BLVD STE 120",
"city": "MIRAMAR",
"state": "FL",
"postal_code": "330236569",
"telephone_number": "305-918-2588",
"fax_number": "305-974-1360"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7451 RIVIERA BLVD STE 120",
"city": "MIRAMAR",
"state": "FL",
"postal_code": "330236569",
"telephone_number": "305-918-2588",
"fax_number": "305-974-1360"
}
],
"practiceLocations": [
{
"address_1": "111 NW 183rd St",
"address_2": "Suite 423",
"address_purpose": "LOCATION",
"city": "Miami",
"state": "FL",
"postal_code": "331694537",
"country_code": "US",
"telephone_number": "305-918-2588",
"fax_number": "305-974-1360",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WIMES",
"first_name": "CASSAUNDRA",
"middle_name": "TENNILLE",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-08-21",
"last_updated": "2022-12-13",
"certification_date": "2022-12-13",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "FL",
"license": "PY 8192",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "013070800",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003127500",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Miramar, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2022; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.