Wise Mountain Medicine LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

WISE MOUNTAIN MEDICINE LLC

Practice address

335 NE Revere Ave
Bend, OR 97701-4059

Phone

(541) 238-7285

NPI assigned

May 25, 2021

Last updated

May 25, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Carlton Andrew Kelch, LACNPI 1558880575

Title

Co-Owner

Phone

(970) 406-1019

Specialties & licenses 1

Addresses

Practitioners 1

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.

• Carlton Andrew Kelch, LAC

  • Acupuncturist
  • Portland, OR
  • NPI 1558880575
  NPD Authorized official

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

{
    "created_epoch": "1621900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621900800000",
    "number": "1316512049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2150 NW HILL ST APT 3",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977031373",
            "telephone_number": "970-406-1019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "335 NE REVERE AVE",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977014059",
            "telephone_number": "541-238-7285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISE MOUNTAIN MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-25",
        "last_updated": "2021-05-25",
        "certification_date": "2021-05-25",
        "status": "A",
        "authorized_official_last_name": "KELCH",
        "authorized_official_first_name": "CARLTON",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "970-406-1019",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "LAC"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Winter, LMFT
• Michelle Naomi Winter, CRM
• Wyatt Winterbottom, LMT
• Elizabeth C Winters, FNP
• Oliver Jayme Wisco, D.O.
• Terra Bahe Wissbaum, PA
• Christine E. Witham, CRM
• Shayla Wittenberg
• Matthew Everett Witts, OTR/L
• Kurt Norman Woeller, D.O.

• Clinic/Center in Bend, OR
• Providers in Bend, OR by specialty
• Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2021; 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.