NPIMap

Organization Active NPI

Well Crest Medical Clinic PLLC

  • Internal Medicine Physician
  • Burleson, TX
National Provider Identifier
1083162093
Registry record updated Sep 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
WELL CREST MEDICAL CLINIC PLLC
Practice address
11803 South Fwy Ste 205
Burleson, TX 76028-7030
Phone
(817) 615-8627
NPI assigned
Sep 19, 2016
Last updated
Sep 19, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2016

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

Authorized official

Name
Meenu Sharma, M.D.NPI 1689610750
Title
President
Phone
(817) 615-8627

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

11803 South Fwy Ste 205
Burleson, TX 76028-7030

Mailing address

13000 Bella Italia CT
Fort Worth, TX 76126-6106
Phone (817) 615-8627

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161205000543 TX Part B Supplier - Clinic/Group Practice 4082994249 Receives reassigned benefits from 12 practitioners
Practice locations: Burleson, TX

National Provider Directory

National Provider Directory

Locations

11797 South Fwy
Ste 246
Burleson, TX 76028
Phone (817) 551-5539

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1474243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474243200000",
    "number": "1083162093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13000 BELLA ITALIA CT",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761266106",
            "telephone_number": "817-615-8627",
            "fax_number": "817-615-8574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11803 SOUTH FWY STE 205",
            "city": "BURLESON",
            "state": "TX",
            "postal_code": "760287030",
            "telephone_number": "817-615-8627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELL CREST MEDICAL CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-19",
        "last_updated": "2016-09-19",
        "status": "A",
        "authorized_official_last_name": "SHARMA",
        "authorized_official_first_name": "MEENU",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "817-615-8627",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burleson, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2016; 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.