Organization Active NPI

Wellmedicine PLLC

  • Internal Medicine Physician
  • Victoria, TX
National Provider Identifier
1558445833
Registry record updated Oct 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
K4757 Issued in TX
Legal business name
WELLMEDICINE PLLC
Practice address
2710 Hospital Dr
Suite 108
Victoria, TX 77901
Phone
(361) 579-1319
Fax
(361) 579-1317
NPI assigned
Oct 24, 2006
Last updated
Oct 18, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2012

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

Authorized official

Name
Dr. Peter Minh NguyenNPI 1902976483
Title
Dr. Nguyen/Internal Medicine
Phone
(361) 579-1319

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
Internal Medicine Physician 207R00000X K4757 TX Primary

Addresses

Primary practice location

2710 Hospital Dr
Suite 108
Victoria, TX 77901

Mailing address

1502 E. Red River PMB 338
Victoria, TX 77901-5523
Phone (361) 579-1319

Other identifiers 1

IdentifierTypeStateIssuer
173838701MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040312001057 TX Part B Supplier - Clinic/Group Practice 6709775141 Receives reassigned benefits from 2 practitioners
Practice locations: Victoria, TX

National Provider Directory

National Provider Directory

Locations

101 James Coleman Dr
Unit A
Victoria, TX 77904
Phone (361) 220-7998

1502 E Red River St
Victoria, TX 77901

2710 Hospital Dr
Ste 108
Victoria, TX 77901
Phone (361) 574-1720

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": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350518400000",
    "number": "1558445833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1502 E. RED RIVER PMB 338",
            "city": "VICTORIA",
            "state": "TX",
            "postal_code": "779015523",
            "telephone_number": "361-579-1319",
            "fax_number": "361-579-1317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2710 HOSPITAL DR",
            "address_2": "SUITE 108",
            "city": "VICTORIA",
            "state": "TX",
            "postal_code": "77901",
            "telephone_number": "361-579-1319",
            "fax_number": "361-579-1317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLMEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-24",
        "last_updated": "2012-10-18",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "MINH",
        "authorized_official_title_or_position": "DR. NGUYEN/INTERNAL MEDICINE",
        "authorized_official_telephone_number": "361-579-1319",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "K4757",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "173838701",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Victoria, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2012; 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.