NPIMap

Organization Active NPI

Restoring Wellness Primary Care LLC

  • Primary Care Clinic/Center
  • Pinellas Park, FL
National Provider Identifier
1467977827
Registry record updated Oct 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
ME103083 Issued in FL
Legal business name
RESTORING WELLNESS PRIMARY CARE LLC
Practice address
10597 US Highway 19 N
Pinellas Park, FL 33782-3413
Phone
(727) 351-1700
Fax
(727) 351-1701
NPI assigned
Aug 7, 2017
Last updated
Oct 11, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2020

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

Authorized official

Name
Dr. Jaimie Lousie Mickey, MDNPI 1255530382
Title
Owner Physician
Phone
(813) 362-5748

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X ME103083 FL Primary

Addresses

Primary practice location

10597 US Highway 19 N
Pinellas Park, FL 33782-3413

Mailing address

5044 Dover St NE
St Petersburg, FL 33703-3215
Phone (813) 362-5748

Other identifiers 1

IdentifierTypeStateIssuer
000994100MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address hello@restoringwellnessmd.com Health Information Exchange (HIE)

National Provider Directory

National Provider Directory

Locations

10597 US Highway 19 N
Pinellas Park, FL 33782
Phone (727) 351-1700

Practitioners & affiliated clinicians

Practitioners 3

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": "1502064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602374400000",
    "number": "1467977827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5044 DOVER ST NE",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337033215",
            "telephone_number": "813-362-5748",
            "fax_number": "737-351-1701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10597 US HIGHWAY 19 N",
            "city": "PINELLAS PARK",
            "state": "FL",
            "postal_code": "337823413",
            "telephone_number": "727-351-1700",
            "fax_number": "727-351-1701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORING WELLNESS PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-07",
        "last_updated": "2020-10-11",
        "certification_date": "2020-10-11",
        "status": "A",
        "authorized_official_last_name": "MICKEY",
        "authorized_official_first_name": "JAIMIE",
        "authorized_official_middle_name": "LOUSIE",
        "authorized_official_title_or_position": "OWNER PHYSICIAN",
        "authorized_official_telephone_number": "813-362-5748",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "FL",
            "license": "ME103083",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000994100",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hello@restoringwellnessmd.com",
            "affiliation": "N",
            "endpointDescription": "Office Manager Email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "10597 US Highway 19 N",
            "city": "Pinellas Park",
            "state": "FL",
            "country_code": "US",
            "postal_code": "337823413",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Pinellas Park, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2020; 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.