NPIMap

Organization Active NPI

Life Wellness Center, Inc.

  • General Practice Physician
  • Lakeville, MN
National Provider Identifier
1083646889
Registry record updated Mar 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
LIFE WELLNESS CENTER, INC.
Practice address
10551 165TH St W
Lakeville, MN 55044-5737
Phone
(952) 435-5300
Fax
(952) 898-1454
NPI assigned
Jul 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2020

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

Authorized official

Name
Dr. Thomas Matthew Schmidt, D.C.NPI 1255349122
Title
Owner/Chiropractor
Phone
(952) 435-5300

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X

Addresses

Primary practice location

10551 165TH St W
Lakeville, MN 55044-5737

Mailing address

10551 165TH St W
Lakeville, MN 55044-5737
Phone (952) 435-5300

Other identifiers 1

IdentifierTypeStateIssuer
025R4LIOtherMNBCBS GROUP ID

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050204000104 MN Part B Supplier - Clinic/Group Practice 3274584438 Receives reassigned benefits from 10 practitioners
Practice locations: Lakeville, MN

National Provider Directory

National Provider Directory

Locations

10551 165th St W
Lakeville, MN 55044
Phone (952) 435-5300

16350 Kenrick Loop
Ste E
Lakeville, MN 55044
Phone (952) 435-5300

Practitioners & affiliated clinicians

Practitioners 28

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 28

NPI Registry JSON

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585180800000",
    "number": "1083646889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10551 165TH ST W",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550445737",
            "telephone_number": "952-435-5300",
            "fax_number": "952-898-1454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10551 165TH ST W",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550445737",
            "telephone_number": "952-435-5300",
            "fax_number": "952-898-1454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE WELLNESS CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2020-03-26",
        "certification_date": "2020-03-26",
        "status": "A",
        "authorized_official_last_name": "SCHMIDT",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "MATTHEW",
        "authorized_official_title_or_position": "OWNER/CHIROPRACTOR",
        "authorized_official_telephone_number": "952-435-5300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP ID",
            "identifier": "025R4LI",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeville, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2020; 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.