Roberta Ann Wildblood, PSYD, MS, RN

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

PY8711 Issued in FL

Practice address

1400 N Semoran Blvd
Suite E
Orlando, FL 32807-3536

Phone

(407) 823-8421

Fax

(407) 823-8195

NPI assigned

Feb 24, 2015

Last updated

Feb 24, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Compass Counseling Services, LLCGroup PAC ID 1456518612, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science, Registered Nurse

Practice roles

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.

• Compass Counseling Services, LLC

  • Community/Behavioral Health Agency
  • Orlando, FL
  • NPI 1891089421
  Medicare reassignment Care Compare group
• Compass Counseling Services,LLC

  • Community/Behavioral Health Agency
  • Orlando, FL
  • NPI 1790157626
  NPD (past)

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

{
    "created_epoch": "1424736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424736000000",
    "number": "1902298250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 N SEMORAN BLVD",
            "address_2": "SUITE E",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328073536",
            "telephone_number": "407-823-8421",
            "fax_number": "407-823-8195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 N SEMORAN BLVD",
            "address_2": "SUITE E",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328073536",
            "telephone_number": "407-823-8421",
            "fax_number": "407-823-8195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDBLOOD",
        "first_name": "ROBERTA",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "PSYD, MS, RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-02-24",
        "last_updated": "2015-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY8711",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "FL",
            "license": "PY8711",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Morgan Lynn Wilcox, AUD
• Timothy David Wilcox, PTA
• Mary Katherine O'Toole Wilczak, APRN
• Wild Hearts Counseling LLC
• Lauren Wilda, DPT
• Elizabeth R Wilder, DO
• Kaley Wilder, ATC
• Terry L Wilder, APRN
• Sherie J Wildermuth
• Kayla Donn Wilfley

• Clinical Child & Adolescent Psychologist in Orlando, FL
• Providers in Orlando, FL by specialty
• Clinical Child & Adolescent Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2015; 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.