Gerolf Engelstatter, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

1140 Issued in NC

Practice address

1703 Country Club Rd
Suite 204
Jacksonville, NC 28546-6006

Phone

(910) 347-3010

Fax

(910) 347-3201

NPI assigned

Dec 16, 2005

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NC

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, 1980

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Carolina Psychological and Psychiatric Health SRVS PAGroup PAC ID 9436059219, 17 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Carolina Psychological and Psychiatric Health SRVS, PA

  • Psychologist
  • Jacksonville, NC
  • NPI 1770561193
  Medicare reassignment Care Compare group
• Resolutions Counseling and Mediation Services, PLLC

  • Clinical Social Worker
  • Jacksonville, NC
  • NPI 1982868501
  NPD (past)

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

{
    "created_epoch": "1134691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679961600000",
    "number": "1932185477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1703 COUNTRY CLUB RD",
            "address_2": "SUITE 204",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285466006",
            "telephone_number": "910-347-3010",
            "fax_number": "910-347-3201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1703 COUNTRY CLUB RD",
            "address_2": "SUITE 204",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285466006",
            "telephone_number": "910-347-3010",
            "fax_number": "910-347-3201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENGELSTATTER",
        "first_name": "GEROLF",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-16",
        "last_updated": "2023-03-28",
        "certification_date": "2023-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NC",
            "license": "1140",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6000579",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "04581",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrea Corrales Emerick
• Ailsa Celeste Emmel, CNM
• Alise D Emmert, CLD
• Emmett M Jones DDS., PA
• Adriane Kacho Eng-Osborne, D.O.
• Mary Engelstatter, PHD
• Monica Michelle Engleson, AGPCNP-BC
• Enlight Psychological & Assessment Services, PLLC
• Jessica Hardin Enyeart, PA-C, MPAS
• Rebecca Tilson Epperson, DPT

• Psychologist in Jacksonville, NC
• Providers in Jacksonville, NC by specialty
• Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2023; 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.