NPIMap

Organization Active NPI

Wellness Concepts Clinic LLC

  • Sports Physician Chiropractor
  • Springfield, MO
National Provider Identifier
1275771669
Registry record updated Jan 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Physician ChiropractorTaxonomy code 111NS0005X
License
2007008411 Issued in MO
Legal business name
WELLNESS CONCEPTS CLINIC LLC
Practice address
1200 E Woodhurst Dr
Ste R 300
Springfield, MO 65804-4261
Phone
(417) 877-1300
Fax
(417) 877-1335
NPI assigned
Jan 23, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2009

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

Authorized official

Name
Dr. Eric Wayne Reavis, DC
Title
Medical Director
Phone
(417) 877-1300

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 2003027886 MO
Sports Physician ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111NS0005X 2007008411 MO Primary
AcupuncturistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 171100000X 2002030343 MO
AcupuncturistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 171100000X 2002024850 MO

Addresses

Primary practice location

1200 E Woodhurst Dr
Ste R 300
Springfield, MO 65804-4261

Mailing address

1200 E Woodhurst Dr
Ste R 300
Springfield, MO 65804-4261
Phone (417) 877-1300

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201204000270 MO Part B Supplier - Clinic/Group Practice 1951712470 Receives reassigned benefits from 4 practitioners
Practice locations: Springfield, MO

National Provider Directory

National Provider Directory
Tax ID family
Wellness Concepts Clinic2 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

1200 E Woodhurst Dr
Ste R300
Springfield, MO 65804
Phone (417) 877-1300

Practitioners & affiliated clinicians

Practitioners 5

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": "1232668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1232668800000",
    "number": "1275771669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 E WOODHURST DR",
            "address_2": "STE R 300",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658044261",
            "telephone_number": "417-877-1300",
            "fax_number": "417-877-1335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 E WOODHURST DR",
            "address_2": "STE R 300",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658044261",
            "telephone_number": "417-877-1300",
            "fax_number": "417-877-1335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLNESS CONCEPTS CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-23",
        "last_updated": "2009-01-23",
        "status": "A",
        "authorized_official_last_name": "REAVIS",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "417-877-1300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "MO",
            "license": "2003027886",
            "primary": false
        },
        {
            "code": "111NS0005X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor, Sports Physician",
            "state": "MO",
            "license": "2007008411",
            "primary": true
        },
        {
            "code": "171100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": "MO",
            "license": "2002030343",
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": "MO",
            "license": "2002024850",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2009; 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.