NPIMap

Organization Active NPI

Wellbe Senior Medical Ohio LLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Independence, OH
National Provider Identifier
1497308456
Registry record updated Sep 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
Legal business name
WELLBE SENIOR MEDICAL OHIO LLC
Practice address
6480 Rockside Woods Blvd S Ste 330
Independence, OH 44131-2222
Phone
(312) 776-2410
NPI assigned
Jul 18, 2019
Last updated
Sep 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2024

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

Authorized official

Name
Dr. Iyad Houshan, MD
Title
Chief Medical Officer
Phone
(702) 236-2929

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Geriatric Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0300X Primary

Addresses

Primary practice location

6480 Rockside Woods Blvd S Ste 330
Independence, OH 44131-2222

Mailing address

225 W Washington St Ste 1700
Chicago, IL 60606-3404
Phone (312) 776-2422

Other names 1

  • WellBe Senior Medical Ohio, Inc Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191111001502 OH Part B Supplier - Clinic/Group Practice 7719319896 Receives reassigned benefits from 31 practitioners
Practice locations: Independence, OH

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D2321998Wellbe Senior Medical Ohio LLC6480 Rockside Woods Blvd South, Independence, OH 44131Certificate of waiverApr 13, 2027

National Provider Directory

National Provider Directory

Locations

6930 Treeline Dr
Ste J
Brecksville, OH 44141
Phone (312) 776-2422

4400 Easton Cmns
Columbus, OH 43219
Phone (702) 236-2929

6480 Rockside Woods Blvd S
Ste 330
Independence, OH 44131
Phone (855) 490-9434

Practitioners & affiliated clinicians

Practitioners 35

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.

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1563408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727308800000",
    "number": "1497308456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 W WASHINGTON ST STE 1700",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606063404",
            "telephone_number": "312-776-2422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6480 ROCKSIDE WOODS BLVD S STE 330",
            "city": "INDEPENDENCE",
            "state": "OH",
            "postal_code": "441312222",
            "telephone_number": "312-776-2410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLBE SENIOR MEDICAL OHIO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-18",
        "last_updated": "2024-09-26",
        "certification_date": "2024-09-26",
        "status": "A",
        "authorized_official_last_name": "HOUSHAN",
        "authorized_official_first_name": "IYAD",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "702-236-2929",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WellBe Senior Medical Ohio, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Independence, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.