Individual provider Active NPI

John F Wellbrock, CRNA

  • Certified Registered Nurse Anesthetist
  • Edgewood, KY
National Provider Identifier
1033195094
Registry record updated Apr 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
038780 Issued in KY
Practice address
1 Medical Village Dr
Independent Anesthesiologists PSC
Edgewood, KY 41017-3403
Phone
(859) 341-7246
Fax
(859) 341-7867
NPI assigned
Dec 21, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 038780 KY Primary
Registered Nurse 163W00000X 1064906 KY

Addresses

Primary practice location

1 Medical Village Dr
Independent Anesthesiologists PSC
Edgewood, KY 41017-3403

Mailing address

PO Box 12749
Covington, KY 41012-0749
Phone (859) 341-7246

Other identifiers 3

IdentifierTypeStateIssuer
0807023MedicaidOH
000000229614OtherANTHEM BLUE SHIELD
74387804MedicaidKY

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

State licenses

LicenseStateTypeSpecialty
181400OHMDAddiction (Substance Use Disorder) Counselor
038780KYMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Trihealth G LLC Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1135123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207008000000",
    "number": "1033195094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12749",
            "city": "COVINGTON",
            "state": "KY",
            "postal_code": "410120749",
            "telephone_number": "859-341-7246",
            "fax_number": "859-341-7867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL VILLAGE DR",
            "address_2": "INDEPENDENT ANESTHESIOLOGISTS PSC",
            "city": "EDGEWOOD",
            "state": "KY",
            "postal_code": "410173403",
            "telephone_number": "859-341-7246",
            "fax_number": "859-341-7867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WELLBROCK",
        "first_name": "JOHN",
        "middle_name": "F",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-21",
        "last_updated": "2008-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KY",
            "license": "038780",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "KY",
            "license": "1064906",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0807023",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE SHIELD",
            "identifier": "000000229614",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "74387804",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edgewood, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.