NPIMap

Organization Active NPI

Innovative Wellness Solutions LLC

  • Surgery Physician
  • Indiana, PA
National Provider Identifier
1255755104
Registry record updated Feb 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
MD044592E Issued in PA
Legal business name
INNOVATIVE WELLNESS SOLUTIONS LLC
Practice address
8075 Route 286 Hwy W
Indiana, PA 15701-8686
Phone
(724) 479-0442
Fax
(724) 479-2930
NPI assigned
Feb 13, 2014
Last updated
Feb 13, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2014

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

Authorized official

Name
Debra A Leonard
Title
Credentialing Manager
Phone
(412) 279-4522

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X MD044592E PA Primary

Addresses

Primary practice location

8075 Route 286 Hwy W
Indiana, PA 15701-8686

Mailing address

8075 Route 286 Hwy W
Indiana, PA 15701-8686
Phone (724) 479-0442

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250424001131 PA DME Supplier - Physician - Family Practice 8426574203 Practice locations: Indiana, PA

National Provider Directory

National Provider Directory
Tax ID family
Innovative Wellness Solutions LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

8075 Route 286 Hwy W
Indiana, PA 15701
Phone (724) 479-0442

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1392249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392249600000",
    "number": "1255755104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8075 ROUTE 286 HWY W",
            "city": "INDIANA",
            "state": "PA",
            "postal_code": "157018686",
            "telephone_number": "724-479-0442",
            "fax_number": "724-479-2930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8075 ROUTE 286 HWY W",
            "city": "INDIANA",
            "state": "PA",
            "postal_code": "157018686",
            "telephone_number": "724-479-0442",
            "fax_number": "724-479-2930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE WELLNESS SOLUTIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-13",
        "last_updated": "2014-02-13",
        "status": "A",
        "authorized_official_last_name": "LEONARD",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "412-279-4522"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "PA",
            "license": "MD044592E",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indiana, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 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.