Active NPI
Eugene E Wenthe Jr., M.D.
- Family Medicine Physician
- Melbourne, FL
National Provider Identifier
1003826918
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- ME117071
- Practice address
- 1223 Gateway Dr Ste 1E
Melbourne, FL 32901-2607 - Phone
- (321) 725-4505
- Fax
- (321) 409-6823
- NPI assigned
- Aug 9, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036061047 | IL | |
| Family Medicine Physician | 207Q00000X | ME117071 | FL | Primary |
Addresses
Primary practice location
1223 Gateway Dr Ste 1E
Melbourne, FL 32901-2607
Mailing address
3300 S Fiske Blvd
Rockledge, FL 32955-4306
Other identifiers 12
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 020057300 | Other | IL | BLACK LUNG |
| 036061047 | Other | IL | IL STATE LICENSE |
| 08421024 | Other | IL | BC/BS |
| 170774 | Other | IL | PERSONAL CARE |
| 036061047 | Medicaid | IL | |
| 054913 | Other | IL | HEALTH ALLIANCE |
| 101343 | Other | IL | HEALTHLINK |
| 6394P | Other | IL | CATERPILLAR |
| CD7143 | Other | IL | RR MEDICARE GROUP |
| 080098256 | Other | IL | RR MEDICARE PIN |
| 133586700 | Other | IL | ACS-OWCP |
| 14D0949277 | Other | IL | CLIA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Physicians Group Associates S C | Past | Accepting new patients | |
| Physicians Group Associates S C | Family Medicine | Past | Accepting new patients |
| Physicians Group Associates S C | Family Medicine | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Internal Medicine Physician
- Springfield, IL
- NPI 1275565988
Family Medicine
-
- Internal Medicine Physician
- Springfield, IL
- NPI 1689606246
Family Medicine
-
- Nurse Practitioner
- Springfield, IL
- NPI 1841216975
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1540944000000",
"number": "1003826918",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3300 S FISKE BLVD",
"city": "ROCKLEDGE",
"state": "FL",
"postal_code": "329554306"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1223 GATEWAY DR STE 1E",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329012607",
"telephone_number": "321-725-4505",
"fax_number": "321-409-6823"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WENTHE",
"first_name": "EUGENE",
"middle_name": "E",
"name_suffix": "Jr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-09",
"last_updated": "2018-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "036061047",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "FL",
"license": "ME117071",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLACK LUNG",
"identifier": "020057300",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IL STATE LICENSE",
"identifier": "036061047",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS",
"identifier": "08421024",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PERSONAL CARE",
"identifier": "170774",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036061047",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH ALLIANCE",
"identifier": "054913",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK",
"identifier": "101343",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CATERPILLAR",
"identifier": "6394P",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE GROUP",
"identifier": "CD7143",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE PIN",
"identifier": "080098256",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ACS-OWCP",
"identifier": "133586700",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CLIA",
"identifier": "14D0949277",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Melbourne, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.