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

Practice address

1019A Vista Park Dr
Forest, VA 24551-4901

Phone

(434) 515-0419

Fax

(844) 693-9305

NPI assigned

Dec 30, 2016

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 identifiers 1

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.

• Luis Angel Matos, M.D., MBA

  • Allergy Physician
  • Forest, VA
  • NPI 1972506509

  Pediatrics, VA

  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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5804426",
            "state": "VA"
        }
    ],
    "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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• All providers in Forest, VA
• 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.