NPIMap

Organization Active NPI

Wellcare Medical Clinic LLC

  • Primary Care Clinic/Center
  • Gambrills, MD
National Provider Identifier
1588316103
Registry record updated Jul 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
WELLCARE MEDICAL CLINIC LLC
Practice address
1438 Defense Hwy Ste 102
Gambrills, MD 21054-2021
Phone
(443) 875-3766
NPI assigned
Jan 25, 2022
Last updated
Jul 25, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2022

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

Authorized official

Name
Sadia CheemaNPI 1144873043
Title
Provider
Phone
(443) 875-3766

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
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

1438 Defense Hwy Ste 102
Gambrills, MD 21054-2021

Mailing address

2524 Ayr CT
Crofton, MD 21114-1682
Phone (443) 875-3766

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220214000157 MD Part B Supplier - Clinic/Group Practice 7315330461 Receives reassigned benefits from 1 practitioner
1 other NPI on this enrollment
Practice locations: Gambrills, MD

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Wellcare Medical Clinic LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1438 Defense Hwy
Ste 102
Gambrills, MD 21054
Phone (410) 231-7007

Practitioners & affiliated clinicians

Practitioners 1

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": "1643068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658707200000",
    "number": "1588316103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2524 AYR CT",
            "city": "CROFTON",
            "state": "MD",
            "postal_code": "211141682",
            "telephone_number": "443-875-3766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1438 DEFENSE HWY STE 102",
            "city": "GAMBRILLS",
            "state": "MD",
            "postal_code": "210542021",
            "telephone_number": "443-875-3766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLCARE MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-25",
        "last_updated": "2022-07-25",
        "certification_date": "2022-07-25",
        "status": "A",
        "authorized_official_last_name": "CHEEMA",
        "authorized_official_first_name": "SADIA",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "443-875-3766"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gambrills, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2022; 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.