Organization Active NPI

Abundant Wellness

  • Nurse Practitioner
  • Ridgeland, MS
National Provider Identifier
1629548359
Registry record updated Feb 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
ABUNDANT WELLNESS
Practice address
101 W Washington St Ste C1
Ridgeland, MS 39157-2434
Phone
(601) 856-2383
NPI assigned
Nov 26, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2020

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

Authorized official

Name
Dana GermanyNPI 1265795678
Title
FNP
Phone
(601) 527-4659

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
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

101 W Washington St Ste C1
Ridgeland, MS 39157-2434

Mailing address

101 W Washington St Ste C1
Ridgeland, MS 39157-2434
Phone (601) 856-2383

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190215000215 MS Part B Supplier - Clinic/Group Practice 2567700651 Receives reassigned benefits from 3 practitioners
Practice locations: Ridgeland, MS

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
25D2181438Abundant Wellness101 W Washington St Ste C1, Ridgeland, MS 39157Certificate of waiverApr 2, 2028

National Provider Directory

National Provider Directory

Locations

101 W Washington St
Ste C
Ridgeland, MS 39157
Phone (601) 856-2383

101 W Washington St
Ste C1
Ridgeland, MS 39157
Phone (601) 527-4659

Practitioners & affiliated clinicians

Practitioners 3

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": "1543190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582761600000",
    "number": "1629548359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 W WASHINGTON ST STE C1",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391572434",
            "telephone_number": "601-856-2383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 W WASHINGTON ST STE C1",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391572434",
            "telephone_number": "601-856-2383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABUNDANT WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-26",
        "last_updated": "2020-02-27",
        "certification_date": "2020-02-27",
        "status": "A",
        "authorized_official_last_name": "GERMANY",
        "authorized_official_first_name": "DANA",
        "authorized_official_title_or_position": "FNP",
        "authorized_official_telephone_number": "601-527-4659"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ridgeland, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2020; 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.