NPIMap

Organization Active NPI

Indian Wells Medical Center

  • Family Medicine Physician
  • Indian Wells, CA
National Provider Identifier
1548288574
Registry record updated Mar 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A83821 Issued in CA
Legal business name
INDIAN WELLS MEDICAL CENTER
Practice address
74976 US Highway 111
Indian Wells, CA 92210-7117
Phone
(760) 568-4544
Fax
(760) 568-4555
NPI assigned
Jul 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2008

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

Authorized official

Name
Dr. Corvin Kelly, D.C.NPI 1134120058
Title
Director/Officer
Phone
(760) 568-4544

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 5

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X DC26074 CA
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X A83821 CA Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X C29564 CA
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X A28654 CA
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X PT19355 CA

Addresses

Primary practice location

74976 US Highway 111
Indian Wells, CA 92210-7117

Mailing address

74976 Highway 111
Indian Wells, CA 92210
Phone (760) 568-4544

Other identifiers 2

IdentifierTypeStateIssuer
ZZZ13979ZOtherCABLUE SHIELD PROVIDER #
ZZZ13978ZOtherCABLUE SHIELD TRI-CARE WEST

Other names 1

  • SPENCER MEDICAL GROUP Former legal business name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

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": "1153094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205539200000",
    "number": "1548288574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "74976 HIGHWAY 111",
            "city": "INDIAN WELLS",
            "state": "CA",
            "postal_code": "92210",
            "telephone_number": "760-568-4544",
            "fax_number": "760-568-4555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "74976 US HIGHWAY 111",
            "city": "INDIAN WELLS",
            "state": "CA",
            "postal_code": "922107117",
            "telephone_number": "760-568-4544",
            "fax_number": "760-568-4555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIAN WELLS MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-17",
        "last_updated": "2008-03-15",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "CORVIN",
        "authorized_official_title_or_position": "DIRECTOR/OFFICER",
        "authorized_official_telephone_number": "760-568-4544",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "DC26074",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A83821",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "C29564",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "CA",
            "license": "A28654",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT19355",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PROVIDER #",
            "identifier": "ZZZ13979Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD TRI-CARE WEST",
            "identifier": "ZZZ13978Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SPENCER MEDICAL GROUP",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Indian Wells, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2008; 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.