NPIMap

Organization Active NPI

Wellspring Family Medicine, PC

  • Psychologist
  • Oakland, MD
National Provider Identifier
1265952998
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
05746 Issued in MD
Legal business name
WELLSPRING FAMILY MEDICINE, PC
Practice address
311 N 4TH St
Oakland, MD 21550-1371
Phone
(301) 334-7855
Fax
(301) 334-7828
NPI assigned
Jun 23, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Ramona Thomas
Title
Operations Manager
Phone
(301) 501-5110

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X 05746 MD Primary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X 12014 MD

Addresses

Primary practice location

311 N 4TH St
Oakland, MD 21550-1371

Mailing address

311 N 4TH St
Oakland, MD 21550-1371
Phone (301) 334-7855

Other practice location 1

106 Cemetery Rd
Accident, MD 21520-2097
Phone (301) 334-7855

Other practice location 2

20 N 3rd St
Oakland, MD 21550-1322
Phone (301) 334-7855

Other identifiers 2

IdentifierTypeStateIssuer
413901100MedicaidMD
3810006442MedicaidWV

Other names 1

  • Wellspring family Medicine Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Wellspring Family Med PC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

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": "1498176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1265952998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 N 4TH ST",
            "city": "OAKLAND",
            "state": "MD",
            "postal_code": "215501371",
            "telephone_number": "301-334-7855",
            "fax_number": "301-334-7828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 N 4TH ST",
            "city": "OAKLAND",
            "state": "MD",
            "postal_code": "215501371",
            "telephone_number": "301-334-7855",
            "fax_number": "301-334-7828"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "106 Cemetery Rd",
            "address_purpose": "LOCATION",
            "city": "Accident",
            "state": "MD",
            "postal_code": "215202097",
            "country_code": "US",
            "telephone_number": "301-334-7855",
            "fax_number": "301-334-7828",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "20 N 3rd St",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "MD",
            "postal_code": "215501322",
            "country_code": "US",
            "telephone_number": "301-334-7855",
            "fax_number": "301-334-7828",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WELLSPRING FAMILY MEDICINE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-23",
        "last_updated": "2022-07-21",
        "certification_date": "2020-04-07",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "RAMONA",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "301-501-5110"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "MD",
            "license": "05746",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "12014",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "413901100",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810006442",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wellspring family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Wellspring family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oakland, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.