Indwell Health and Wellness.LLC

Primary specialty

Allergy & Immunology PhysicianTaxonomy code 207K00000X

License

0101056392 Issued in VA

Legal business name

INDWELL HEALTH AND WELLNESS.LLC

Doing business as

Allergy and Asthma of Virginia

Practice address

1019A Vista Park Dr
Forest, VA 24551-4901

Phone

(434) 515-0419

Fax

(844) 693-9305

NPI assigned

Dec 30, 2016

Last updated

Apr 12, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Luis A Matos, MDNPI 1972506509

Title

Medical Director

Phone

(434) 252-0026

Specialties & licenses 3

Addresses

Other names 1

• Allergy and Asthma of Virginia Doing business as

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Locations

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.

• Luis Angel Matos, M.D., MBA

  • Allergy Physician
  • Forest, VA
  • NPI 1972506509

  Pediatrics

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1483056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523491200000",
    "number": "1689119646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13103",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240313103",
            "telephone_number": "434-251-0026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1019A VISTA PARK DR",
            "city": "FOREST",
            "state": "VA",
            "postal_code": "245514901",
            "telephone_number": "434-515-0419",
            "fax_number": "844-693-9305"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1315 2nd St SW Ste 101A",
            "address_purpose": "LOCATION",
            "city": "Roanoke",
            "state": "VA",
            "postal_code": "240164935",
            "country_code": "US",
            "telephone_number": "540-384-1797",
            "fax_number": "844-693-9305",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4500 Riverside Dr Ste B-1",
            "address_purpose": "LOCATION",
            "city": "Danville",
            "state": "VA",
            "postal_code": "245415167",
            "country_code": "US",
            "telephone_number": "434-252-0026",
            "fax_number": "844-693-9305",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INDWELL HEALTH AND WELLNESS.LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-30",
        "last_updated": "2018-04-12",
        "status": "A",
        "authorized_official_last_name": "MATOS",
        "authorized_official_first_name": "LUIS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "434-252-0026",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Allergy & Immunology",
            "state": "VA",
            "license": "0101056392",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0101056392",
            "primary": false
        },
        {
            "code": "2080P0201X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Allergy/Immunology",
            "state": "VA",
            "license": "0101056392",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Allergy and Asthma of Virginia",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Allergy and Asthma of Virginia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Allergy & Immunology Physician in Forest, VA
• Providers in Forest, VA by specialty
• Allergy & Immunology Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2018; 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.