Roger Todd Dewilde, M.ED. LPC-MHSP(TEMP)

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

3695 Issued in TN

Practice address

332 Sumner Hall Dr
Gallatin, TN 37066-3129

Phone

(615) 460-4500

NPI assigned

Aug 19, 2017

Last updated

Aug 19, 2017By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2015

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Education

Practice roles

Locations

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.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  TN

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1503100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1503100800000",
    "number": "1871019034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "332 SUMNER HALL DR",
            "city": "GALLATIN",
            "state": "TN",
            "postal_code": "370663129",
            "telephone_number": "615-460-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "332 SUMNER HALL DR",
            "city": "GALLATIN",
            "state": "TN",
            "postal_code": "370663129",
            "telephone_number": "615-460-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEWILDE",
        "first_name": "ROGER",
        "middle_name": "TODD",
        "credential": "M.ED. LPC-MHSP(TEMP)",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-08-19",
        "last_updated": "2017-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "TN",
            "license": "3695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ellie J Demoss, SLP-CCC
• Raymond B Demoville, MD
• Dermal Dynamics
• Jessica Spears Derusha, RDH
• Amber Devore, OT
• Dialysis Associates, LLC (Fresenius Medical Care Gallatin)
• Courtney E. Dickens, MSN, APN, FNP-BC
• Reginald Peeler Dickerson, M.D
• Shaw Stanford Dickerson, DPT
• Raegan Ann Marie Diller, MD

• Mental Health Counselor in Gallatin, TN
• Providers in Gallatin, TN by specialty
• Mental Health Counselor in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2017; 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.

Verify at the official NPI Registry.