NPIMap

Organization Active NPI

Wellspring Clinical Associates, Inc.

  • Psychiatry Physician
  • Lisle, IL
National Provider Identifier
1164562609
Registry record updated Oct 7, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
WELLSPRING CLINICAL ASSOCIATES, INC.
Practice address
5950 Lincoln Ave
Unit W
Lisle, IL 60532-3388
Phone
(630) 541-8930
Fax
(630) 541-8940
NPI assigned
Feb 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2009

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

Authorized official

Name
Dr. Thomas Leo Dimatteo, M.D.NPI 1487601985
Title
President
Phone
(630) 541-8930

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

5950 Lincoln Ave
Unit W
Lisle, IL 60532-3388

Mailing address

5950 Lincoln Ave
Unit W
Lisle, IL 60532-3388
Phone (630) 541-8930

Other identifiers 3

IdentifierTypeStateIssuer
022-32842OtherBC/BS
02227624OtherBLUE CROSS BLUE SHIELD
02232842OtherILBLUE CROSS BLUE SHIELD

Other names 1

  • Integrated Healthcare Solutions Inc Former legal business name

National Provider Directory

National Provider Directory

Locations

5950 Lincoln Ave
Ste W
Lisle, IL 60532
Phone (630) 541-8930

1601 Bond St
Ste 316
Naperville, IL 60563
Phone (630) 305-3701

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254873600000",
    "number": "1164562609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5950 LINCOLN AVE",
            "address_2": "UNIT W",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605323388",
            "telephone_number": "630-541-8930",
            "fax_number": "630-541-8940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5950 LINCOLN AVE",
            "address_2": "UNIT W",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605323388",
            "telephone_number": "630-541-8930",
            "fax_number": "630-541-8940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSPRING CLINICAL ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2009-10-07",
        "status": "A",
        "authorized_official_last_name": "DIMATTEO",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "LEO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-541-8930",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "022-32842",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "02227624",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "02232842",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Integrated Healthcare Solutions Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Lisle, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2009; 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.