NPIMap

Organization Active NPI

Dream Team Wellness LLC

Doing business as Squareone Aesthetics and Wellness

  • Primary Care Clinic/Center
  • Tallahassee, FL
National Provider Identifier
1285311431
Registry record updated Oct 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
DREAM TEAM WELLNESS LLC
Doing business as
Squareone Aesthetics and Wellness
Practice address
857 E Park Ave
Tallahassee, FL 32301-2620
Phone
(850) 765-9923
Fax
(904) 339-9322
NPI assigned
Jun 29, 2023
Last updated
Oct 22, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2023

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

Authorized official

Name
Dr. Timothy Woodfin Walker, MDNPI 1679525463
Title
President
Phone
(850) 904-6767

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
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

857 E Park Ave
Tallahassee, FL 32301-2620

Mailing address

857 E Park Ave
Tallahassee, FL 32301-2620
Phone (850) 765-9923

Other names 1

  • SQUAREONE AESTHETICS AND WELLNESS Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231027000335 FL Part B Supplier - Clinic/Group Practice 6507212594 Receives reassigned benefits from 1 practitioner
Practice locations: Tallahassee, FL

National Provider Directory

National Provider Directory

Locations

857 E Park Ave
Tallahassee, FL 32301
Phone (757) 251-0879

863 E Park Ave
Tallahassee, FL 32301
Phone (850) 765-9923

Practitioners & affiliated clinicians

Practitioners 4

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": "1687996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697932800000",
    "number": "1285311431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "857 E PARK AVE",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323012620",
            "telephone_number": "850-765-9923",
            "fax_number": "904-339-9322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "857 E PARK AVE",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323012620",
            "telephone_number": "850-765-9923",
            "fax_number": "904-339-9322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DREAM TEAM WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-29",
        "last_updated": "2023-10-22",
        "certification_date": "2023-10-22",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "WOODFIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "850-904-6767",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SQUAREONE AESTHETICS AND WELLNESS",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SQUAREONE AESTHETICS AND WELLNESS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tallahassee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2023; 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.