Wellington Provider Group, PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

WELLINGTON PROVIDER GROUP, PC

Practice address

10260 SW Greenburg Rd FL 4
Portland, OR 97223-5500

Phone

(859) 439-0400

NPI assigned

Dec 19, 2022

Organization subpart

Yes

Parent organization

WELLINGTON PROVIDER GROUP, PCAs reported in NPPES

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

Authorized official

Name

Mariela Bravo

Title

Credentialing Team Lead

Phone

(831) 313-6799

Specialties & licenses 1

Addresses

Part of

Wellington Provider Group P

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

{
    "created_epoch": "1671408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671408000000",
    "number": "1619689957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "535 WELLINGTON WAY STE 330",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405031331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10260 SW GREENBURG RD FL 4",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972235500",
            "telephone_number": "859-439-0400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLINGTON PROVIDER GROUP, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WELLINGTON PROVIDER GROUP, PC",
        "enumeration_date": "2022-12-19",
        "last_updated": "2022-12-19",
        "certification_date": "2022-12-19",
        "status": "A",
        "authorized_official_last_name": "BRAVO",
        "authorized_official_first_name": "MARIELA",
        "authorized_official_title_or_position": "CREDENTIALING TEAM LEAD",
        "authorized_official_telephone_number": "831-313-6799"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kirk L Weller, M.D.
• Ryan Weller, LCSW
• Samantha Weller
• Christine Wellert
• Wellify Health
• Jeffrey Wellington, MSW, LCSW, CADC-I
• Ryan P Wellington, MS, OTR/L
• Deborah Ann Welliver, FNP-C
• Jacob Andrew Welliver
• Zaire Mali Wellmon

• Family Medicine Physician in Portland, OR
• Providers in Portland, OR by specialty
• Family Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2022; 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.