NPIMap

Organization Active NPI

Wellford Medicine, LLC

Doing business as Wellford Family Medicine

  • Family Medicine Physician
  • Wellford, SC
National Provider Identifier
1407541022
Registry record updated Apr 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
WELLFORD MEDICINE, LLC
Doing business as
Wellford Family Medicine
Practice address
102 Astor St
Wellford, SC 29385-9622
Phone
(864) 439-5338
Fax
(864) 439-4769
NPI assigned
Apr 10, 2023
Last updated
Apr 12, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2023

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

Authorized official

Name
Misty Petras, FNPNPI 1912341470
Title
Owner
Phone
(864) 439-5338

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
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

102 Astor St
Wellford, SC 29385-9622

Mailing address

102 Astor St
Wellford, SC 29385-9622
Phone (864) 439-5338

Other names 1

  • Wellford Family Medicine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230719001871 SC Part B Supplier - Clinic/Group Practice 3870953029 Receives reassigned benefits from 2 practitioners
Practice locations: Wellford, SC

National Provider Directory

National Provider Directory

Locations

102 Astor St
Wellford, SC 29385
Phone (864) 437-5338

Practitioners & affiliated clinicians

Practitioners 5

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": "1681084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681257600000",
    "number": "1407541022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 ASTOR ST",
            "city": "WELLFORD",
            "state": "SC",
            "postal_code": "293859622",
            "telephone_number": "864-439-5338",
            "fax_number": "864-439-4769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 ASTOR ST",
            "city": "WELLFORD",
            "state": "SC",
            "postal_code": "293859622",
            "telephone_number": "864-439-5338",
            "fax_number": "864-439-4769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLFORD MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-10",
        "last_updated": "2023-04-12",
        "certification_date": "2023-04-12",
        "status": "A",
        "authorized_official_last_name": "PETRAS",
        "authorized_official_first_name": "MISTY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "864-439-5338",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wellford Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wellford, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 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.