Ilivewell Nutrition Therapy LLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

DT80445 Issued in TX

Legal business name

ILIVEWELL NUTRITION THERAPY LLC

Doing business as

iLiveWell Nutrition

Practice address

3724 Jefferson St
Suite 316
Austin, TX 78731-6225

Phone

(512) 547-9274

NPI assigned

May 6, 2013

Last updated

May 1, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Adrien B Paczosa, RD, LD, CEDRD-S

Title

Owner

Phone

(512) 547-9274

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• iLiveWell Nutrition Doing business as

Electronic endpoints 1

Locations

Practitioners 2

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.

• Samantha Humpal, MS, RDN, LDN

  • Registered Dietitian
  • Twinsburg, OH
  • NPI 1427884147

  Dietitian, Registered

  NPD
• Melanie Burke Sanders, RD, LD

  • Registered Dietitian
  • Austin, TX
  • NPI 1528422466

  Dietitian, Registered

  NPD (past)

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

{
    "created_epoch": "1367798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588291200000",
    "number": "1093150070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3724 JEFFERSON ST",
            "address_2": "SUITE 316",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787316225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3724 JEFFERSON ST",
            "address_2": "SUITE 316",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787316225",
            "telephone_number": "512-547-9274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILIVEWELL NUTRITION THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-06",
        "last_updated": "2020-05-01",
        "certification_date": "2020-05-01",
        "status": "A",
        "authorized_official_last_name": "PACZOSA",
        "authorized_official_first_name": "ADRIEN",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "512-547-9274",
        "authorized_official_credential": "RD, LD, CEDRD-S"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "TX",
            "license": "DT80445",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1700077062",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "SimplePractice.com",
            "affiliation": "N",
            "endpointDescription": "Simple Practice EHR",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "SimplePractice.com",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Simple Practice",
            "address_1": "3724 Jefferson St",
            "address_2": "Suite 316",
            "city": "Austin",
            "state": "TX",
            "country_code": "US",
            "postal_code": "787316225",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "iLiveWell Nutrition",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Registered Dietitian in Austin, TX
• Providers in Austin, TX by specialty
• Registered Dietitian in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2020; 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.