NPIMap

Organization Active NPI

Wellmed Medical Group, P.a.

Doing business as WellMed Shoreline Senior Clinic

  • Family Medicine Physician
  • Corpus Christi, TX
National Provider Identifier
1154629434
Registry record updated Feb 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
WELLMED MEDICAL GROUP, P.A.
Doing business as
WellMed Shoreline Senior Clinic
Practice address
1215 Santa Fe St.
Corpus Christi, TX 78404-2338
Phone
(361) 884-9900
Fax
(361) 884-9903
NPI assigned
Mar 10, 2011
Last updated
Feb 24, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2014

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

Authorized official

Name
Dr. Carlos O Hernandez, M.D.
Title
President
Phone
(210) 877-7570

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary
Internal Medicine Physician 207R00000X

Addresses

Primary practice location

1215 Santa Fe St.
Corpus Christi, TX 78404-2338

Mailing address

8637 Fredericksburg Road, Suite 360
Attn: Director of Accounts Receivable
San Antonio, TX 78240-1285
Phone (210) 877-7570

Other names 1

  • WellMed Shoreline Senior Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041105000519 TX Part B Supplier - Clinic/Group Practice 4880657386 Receives reassigned benefits from 880 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

2510 E Main St
Ste 102
Alice, TX 78332
Phone (361) 664-4445

2260 Trawood Dr
Ste C
El Paso, TX 79935
Phone (915) 591-4632

4774 Loma del Sur Dr
El Paso, TX 79934
Phone (915) 751-7773

Practitioners & affiliated clinicians

Practitioners 44

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.

View all 44

NPI Registry JSON

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

{
    "created_epoch": "1299715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1393200000000",
    "number": "1154629434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8637 FREDERICKSBURG ROAD, SUITE 360",
            "address_2": "ATTN: DIRECTOR OF ACCOUNTS RECEIVABLE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782401285",
            "telephone_number": "210-877-7570",
            "fax_number": "210-641-2235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 SANTA FE ST.",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "784042338",
            "telephone_number": "361-884-9900",
            "fax_number": "361-884-9903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLMED MEDICAL GROUP, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-10",
        "last_updated": "2014-02-24",
        "status": "A",
        "authorized_official_last_name": "HERNANDEZ",
        "authorized_official_first_name": "CARLOS",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "210-877-7570",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WellMed Shoreline Senior Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Corpus Christi, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.