Individual provider Active NPI

Charles Vincent Wellman, M.D.

  • Internal Medicine Physician
  • Cleveland, OH
National Provider Identifier
1093887382
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
35.047616 Issued in OH
Practice address
300 E 185TH St
Cleveland, OH 44119-1330
Phone
(216) 383-3775
Fax
(216) 383-3750
NPI assigned
Nov 14, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 35.047616 OH Primary

Addresses

Primary practice location

300 E 185TH St
Cleveland, OH 44119-1330

Mailing address

300 E 185TH St
Cleveland, OH 44119-1330
Phone (216) 383-3775

Other identifiers 2

IdentifierTypeStateIssuer
35.047616OtherOHSTATE LICENSE
0820106MedicaidOH

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
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35.047616OHMDInternal Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1093887382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E 185TH ST",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441191330",
            "telephone_number": "216-383-3775",
            "fax_number": "216-383-3750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 E 185TH ST",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441191330",
            "telephone_number": "216-383-3775",
            "fax_number": "216-383-3750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WELLMAN",
        "first_name": "CHARLES",
        "middle_name": "VINCENT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35.047616",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "35.047616",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0820106",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.