NPIMap

Organization Active NPI

New Image Body and Wellness Clinic, PC

  • Primary Care Clinic/Center
  • Waterford, MI
National Provider Identifier
1679523278
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
06914E Issued in MI
Legal business name
NEW IMAGE BODY AND WELLNESS CLINIC, PC
Practice address
2590 Elizabeth Lake Rd
Waterford, MI 48328-3314
Phone
(248) 682-6627
NPI assigned
May 12, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Barbara Jean Kacel, FNP-CNPI 1831172600
Title
Family Nurse Practitioner
Phone
(248) 682-6627

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 06914E MI Primary

Addresses

Primary practice location

2590 Elizabeth Lake Rd
Waterford, MI 48328-3314

Mailing address

1396 Scott Lake Rd
Waterford, MI 48328-1578
Phone (248) 682-6627

National Provider Directory

National Provider Directory

Locations

4576 W Walton Blvd
Waterford, MI 48329
Phone (248) 618-3920

Practitioners & affiliated clinicians

Practitioners 18

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.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1679523278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1396 SCOTT LAKE RD",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483281578",
            "telephone_number": "248-682-6627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2590 ELIZABETH LAKE RD",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483283314",
            "telephone_number": "248-682-6627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW IMAGE BODY AND WELLNESS CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KACEL",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "FAMILY NURSE PRACTITIONER",
        "authorized_official_telephone_number": "248-682-6627",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MI",
            "license": "06914E",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterford, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.