Organization Active NPI

KC Integrative Wellness. LLC

  • Family Medicine Physician
  • Crestview, FL
National Provider Identifier
1265299077
Registry record updated Jan 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
KC INTEGRATIVE WELLNESS. LLC
Practice address
327 Medcrest Dr Unit a
Crestview, FL 32536-6464
Phone
(850) 699-0736
NPI assigned
Feb 28, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2025

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

Authorized official

Name
Kate R Lops, MDNPI 1518938653
Title
Physician
Phone
(850) 699-0736

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
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

327 Medcrest Dr Unit a
Crestview, FL 32536-6464

Mailing address

328 Kelly Plantation Dr
Destin, FL 32541-3475
Phone (850) 699-0736

Other names 1

  • Integrative Wellness Clini Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240701001733 FL Part B Supplier - Clinic/Group Practice 3779027800 Receives reassigned benefits from 1 practitioner
Practice locations: Crestview, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D1059559KC Integrative Wellness LLC327 Medcrest Drive Unit a, Crestview, FL 32536Certificate of waiverFeb 11, 2028

National Provider Directory

National Provider Directory

Locations

327 Medcrest Dr
Unit A
Crestview, FL 32536
Phone (850) 423-0761

Practitioners & affiliated clinicians

Practitioners 1

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": "1709078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736726400000",
    "number": "1265299077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "328 KELLY PLANTATION DR",
            "city": "DESTIN",
            "state": "FL",
            "postal_code": "325413475",
            "telephone_number": "850-699-0736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "327 MEDCREST DR UNIT A",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325366464",
            "telephone_number": "850-699-0736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KC INTEGRATIVE WELLNESS. LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-28",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A",
        "authorized_official_last_name": "LOPS",
        "authorized_official_first_name": "KATE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "850-699-0736",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Integrative Wellness Clini",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Integrative Wellness Clini",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Crestview, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.