Organization Active NPI

Bain Complete Wellness LLC.

Doing business as Bain Complete Wellness

  • Family Medicine Physician
  • Tampa, FL
National Provider Identifier
1376889519
Registry record updated Mar 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME115880 Issued in FL
Legal business name
BAIN COMPLETE WELLNESS LLC.
Doing business as
Bain Complete Wellness
Practice address
10311 Cross Creek Blvd Ste E
Tampa, FL 33647-2989
Phone
(813) 574-2460
NPI assigned
Dec 17, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2023

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

Authorized official

Name
Dr. Timothy F. Bain, DCNPI 1538388566
Title
President
Phone
(813) 907-9898

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X CH8562 FL
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X ME115880 FL Primary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X PT20198 FL

Addresses

Primary practice location

10311 Cross Creek Blvd Ste E
Tampa, FL 33647-2989

Mailing address

10311 Cross Creek Blvd Ste E
Tampa, FL 33647-2989
Phone (813) 574-2460

Other practice location 1

2901 Busch Lake Blvd
Tampa, FL 33614-1860
Phone (813) 936-7979

Other names 1

  • Bain Complete Wellness Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130425000082 FL Part B Supplier - Clinic/Group Practice 9638315302 Receives reassigned benefits from 6 practitioners
Practice locations: Riverview, FL; Wesley Chapel, FL; Tampa, FL

National Provider Directory

National Provider Directory

Locations

10311 Cross Creek Blvd
Ste E
Tampa, FL 33647
Phone (813) 574-2460

Practitioners & affiliated clinicians

Practitioners 8

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": "1355702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677715200000",
    "number": "1376889519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10311 CROSS CREEK BLVD STE E",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336472989",
            "telephone_number": "813-574-2460",
            "fax_number": "813-949-5001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10311 CROSS CREEK BLVD STE E",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336472989",
            "telephone_number": "813-574-2460"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2901 Busch Lake Blvd",
            "address_purpose": "LOCATION",
            "city": "Tampa",
            "state": "FL",
            "postal_code": "336141860",
            "country_code": "US",
            "telephone_number": "813-936-7979",
            "fax_number": "813-936-1600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BAIN COMPLETE WELLNESS LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-17",
        "last_updated": "2023-03-02",
        "certification_date": "2023-03-02",
        "status": "A",
        "authorized_official_last_name": "BAIN",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "813-907-9898",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH8562",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME115880",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT20198",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bain Complete Wellness",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bain Complete Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tampa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 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.