Active NPI
Richard Mark Wolff, MD
- Pediatrics Physician
- Donalsonville, GA
National Provider Identifier
1154424596
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- ME36950
- Practice address
- 205 Bresee St
Donalsonville, GA 39845 - Phone
- (229) 524-1307
- Fax
- (229) 524-6268
- NPI assigned
- Sep 7, 2006
- Last updated
- Jul 9, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | ME36950 | FL | Primary |
Addresses
Primary practice location
205 Bresee St
Donalsonville, GA 39845
Mailing address
205 Bresee St
Donalsonville, GA 39845
Phone (229) 524-1307
Other identifiers 9
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 202228700 | Other | FL | UNITED HEALTHCARE |
| 222439 | Other | FL | STAYWELL |
| 202228700 | Other | FL | TRICARE |
| 4200788 | Other | FL | AETNA |
| 065505800 | Medicaid | FL | |
| 95515 | Other | FL | BSF |
| 202228700 | Other | FL | HUMANA |
| 008197 | Other | FL | AVMED |
| 222439 | Other | FL | HEALTHEASE |
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
| License | State | Type | Specialty |
|---|---|---|---|
| ME36950 | FL | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157587200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1215561600000",
"number": "1154424596",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "205 BRESEE ST",
"city": "DONALSONVILLE",
"state": "GA",
"postal_code": "39845",
"telephone_number": "229-524-1307",
"fax_number": "229-524-6268"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "205 BRESEE ST",
"city": "DONALSONVILLE",
"state": "GA",
"postal_code": "39845",
"telephone_number": "229-524-1307",
"fax_number": "229-524-6268"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOLFF",
"first_name": "RICHARD",
"middle_name": "MARK",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-07",
"last_updated": "2008-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "FL",
"license": "ME36950",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "202228700",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STAYWELL",
"identifier": "222439",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "202228700",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4200788",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "065505800",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BSF",
"identifier": "95515",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HUMANA",
"identifier": "202228700",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AVMED",
"identifier": "008197",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHEASE",
"identifier": "222439",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Donalsonville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.