NPIMap

Organization Active NPI

Wellspring Psychology Group LLC

  • Clinical Psychologist
  • Florence, SC
National Provider Identifier
1255756565
Registry record updated Feb 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
1073 Issued in SC
Legal business name
WELLSPRING PSYCHOLOGY GROUP LLC
Practice address
1340 Celebration Blvd
Unit a
Florence, SC 29501-5585
Phone
(843) 536-1180
Fax
(843) 536-1116
NPI assigned
Feb 24, 2014
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. Jason Dean Anderson, PSYDNPI 1942481882
Title
Partner
Phone
(812) 797-7069

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
Clinical Psychologist 103TC0700X 1073 SC Primary

Addresses

Primary practice location

1340 Celebration Blvd
Unit a
Florence, SC 29501-5585

Mailing address

1340 Celebration Blvd
Unit a
Florence, SC 29501-5585
Phone (843) 536-1180

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140519002263 SC Part B Supplier - Clinic/Group Practice 9537382692 Receives reassigned benefits from 17 practitioners
Practice locations: Florence, SC

National Provider Directory

National Provider Directory

Locations

1340 Celebration Blvd
Florence, SC 29501
Phone (843) 536-1180

1340 Celebration Blvd
Unit A
Florence, SC 29501
Phone (843) 536-1180

Practitioners & affiliated clinicians

Practitioners 28

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 28

NPI Registry JSON

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

{
    "created_epoch": "1393200000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1393200000000",
    "number": "1255756565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1340 CELEBRATION BLVD",
            "address_2": "UNIT A",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295015585",
            "telephone_number": "843-536-1180",
            "fax_number": "843-536-1116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1340 CELEBRATION BLVD",
            "address_2": "UNIT A",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295015585",
            "telephone_number": "843-536-1180",
            "fax_number": "843-536-1116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSPRING PSYCHOLOGY GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-24",
        "last_updated": "2014-02-24",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "DEAN",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "812-797-7069",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "SC",
            "license": "1073",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Florence, SC

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.