Wellcare Health Center Med Group Inc,

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

WELLCARE HEALTH CENTER MED GROUP INC,

Practice address

631 E Colorado St
Glendale, CA 91205-1797

Phone

(818) 507-8181

Fax

(818) 507-9431

NPI assigned

Aug 24, 2020

Organization subpart

No

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

Authorized official

Name

Veronica Baghdasaryan

Title

Office Manager

Phone

(818) 484-7092

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 2

• WellCare Center Med Group Inc, Former legal business name
• WellCare Health Center Med Group Inc, Former legal business name

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1598227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607472000000",
    "number": "1215540836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "631 E COLORADO ST",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912051797",
            "telephone_number": "818-484-7092",
            "fax_number": "818-337-0436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "631 E COLORADO ST",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912051797",
            "telephone_number": "818-507-8181",
            "fax_number": "818-507-9431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLCARE HEALTH CENTER MED GROUP INC,",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-24",
        "last_updated": "2020-12-09",
        "certification_date": "2020-12-09",
        "status": "A",
        "authorized_official_last_name": "BAGHDASARYAN",
        "authorized_official_first_name": "VERONICA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "818-484-7092"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "A66411",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "glendale",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "631 E Colorado St",
            "city": "Glendale",
            "state": "CA",
            "country_code": "US",
            "postal_code": "912051797",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "WellCare Center Med Group Inc,",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "WellCare Health Center Med Group Inc,",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "WellCare Health Center Med Group Inc,",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Melinda A Welch, MFCC
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• Well Nest Home Health Care
• Wellhealth,LLC.
• Wellness Empire
• Wellness Home Health Care, Inc.
• Wellness P.T. & Rehab, Inc
• Wellness Works

• Family Medicine Physician in Glendale, CA
• Providers in Glendale, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2020; 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.