Individual provider Active NPI

James Lars Wellington Jr., O.D.

  • Optometrist
  • Goshen, IN
National Provider Identifier
1104938547
Registry record updated Jul 28, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
18002859 Issued in IN
Practice address
116 W Washington St
Goshen, IN 46526-3729
Phone
(574) 533-7345
Fax
(574) 533-5683
NPI assigned
Aug 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 18002859 IN Primary

Addresses

Primary practice location

116 W Washington St
Goshen, IN 46526-3729

Mailing address

116 W Washington St
Goshen, IN 46526-3729
Phone (574) 533-7345

Other identifiers 1

IdentifierTypeStateIssuer
200126500AMedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101030000183 IN Practitioner - Optometry 7315058104 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Indiana University - School of Optometry, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellington and Weddell Eye Care, PCGroup PAC ID 8022096676, 2 clinicians

Practice addresses (Care Compare)

116 W Washington St
Goshen, IN 46526-3729
Phone (574) 533-7345

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
18002859INMDOptometrist

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280275200000",
    "number": "1104938547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 W WASHINGTON ST",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465263729",
            "telephone_number": "574-533-7345",
            "fax_number": "574-533-5683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 W WASHINGTON ST",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465263729",
            "telephone_number": "574-533-7345",
            "fax_number": "574-533-5683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WELLINGTON",
        "first_name": "JAMES",
        "middle_name": "LARS",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2010-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18002859",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200126500A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Goshen, IN

Sources for this page

Verify at the official NPI Registry.