Organization Active NPI

Wellness and Weight Loss

  • General Practice Physician
  • Trussville, AL
National Provider Identifier
1073882700
Registry record updated Dec 27, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
WELLNESS AND WEIGHT LOSS
Practice address
4735 Norrel Dr
Suite 109
Trussville, AL 35173-3603
Phone
(205) 655-9355
Fax
(205) 655-9354
NPI assigned
Dec 27, 2011
Last updated
Dec 27, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2011

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

Authorized official

Name
Mr. Derek Watkins, RN
Title
Office Manager
Phone
(205) 655-9355

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X NU Primary

Addresses

Primary practice location

4735 Norrel Dr
Suite 109
Trussville, AL 35173-3603

Mailing address

4735 Norrel Dr
Suite 109
Trussville, AL 35173-3603
Phone (205) 655-9355

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181206003300 AL Part B Supplier - Clinic/Group Practice 7416291125 Receives reassigned benefits from 2 practitioners
Practice locations: Trussville, AL

National Provider Directory

National Provider Directory

Locations

4735 Norrel Dr
Ste 109
Trussville, AL 35173
Phone (205) 455-9355

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1324944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324944000000",
    "number": "1073882700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4735 NORREL DR",
            "address_2": "SUITE 109",
            "city": "TRUSSVILLE",
            "state": "AL",
            "postal_code": "351733603",
            "telephone_number": "205-655-9355",
            "fax_number": "205-655-9354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4735 NORREL DR",
            "address_2": "SUITE 109",
            "city": "TRUSSVILLE",
            "state": "AL",
            "postal_code": "351733603",
            "telephone_number": "205-655-9355",
            "fax_number": "205-655-9354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLNESS AND WEIGHT LOSS",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-27",
        "last_updated": "2011-12-27",
        "status": "A",
        "authorized_official_last_name": "WATKINS",
        "authorized_official_first_name": "DEREK",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "205-655-9355",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Trussville, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.