Wellbe Senior Medical Group of Arizona LLC

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

Legal business name

WELLBE SENIOR MEDICAL GROUP OF ARIZONA LLC

Practice address

20 W Kinzie St Ste 17
Chicago, IL 60654-6393

Phone

(312) 776-2422

NPI assigned

May 11, 2021

Organization subpart

No

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

Authorized official

Name

Iyad Houshan, MD

Title

Chief Medical Officer

Phone

(312) 776-2415

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1620691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620691200000",
    "number": "1104400506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 W KINZIE ST STE 17",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606546393",
            "telephone_number": "312-776-2422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 W KINZIE ST STE 17",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606546393",
            "telephone_number": "312-776-2422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLBE SENIOR MEDICAL GROUP OF ARIZONA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-11",
        "last_updated": "2021-05-11",
        "certification_date": "2021-05-11",
        "status": "A",
        "authorized_official_last_name": "HOUSHAN",
        "authorized_official_first_name": "IYAD",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "312-776-2415",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Providers in Chicago, IL by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2021; 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.