NPIMap

Organization Active NPI

Center State Wellness LLC

  • Family Nurse Practitioner
  • Concord, NH
National Provider Identifier
1689235319
Registry record updated Jun 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
CENTER STATE WELLNESS LLC
Practice address
102 Pleasant St
Concord, NH 03301-3863
Phone
(603) 556-7101
Fax
(949) 404-6458
NPI assigned
Jun 24, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2019

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

Authorized official

Name
Mr. Russell Howard, FNPNPI 1275954166
Title
Authorized Official
Phone
(603) 556-7101

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
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X Primary

Addresses

Primary practice location

102 Pleasant St
Concord, NH 03301-3863

Mailing address

102 Pleasant St
Concord, NH 03301-3863
Phone (603) 556-7101

Other practice location 1

26 Water St
Keene, NH 03431-4235
Phone (603) 556-7101

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191202001013 NH Part B Supplier - Clinic/Group Practice 4385077577 Receives reassigned benefits from 6 practitioners
Practice locations: Concord, NH

National Provider Directory

National Provider Directory
Tax ID family
Center State Wellness LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 7

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": "1561334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561334400000",
    "number": "1689235319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 PLEASANT ST",
            "city": "CONCORD",
            "state": "NH",
            "postal_code": "033013863",
            "telephone_number": "603-556-7101",
            "fax_number": "949-404-6458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 PLEASANT ST",
            "city": "CONCORD",
            "state": "NH",
            "postal_code": "033013863",
            "telephone_number": "603-556-7101",
            "fax_number": "949-404-6458"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "26 Water St",
            "address_purpose": "LOCATION",
            "city": "Keene",
            "state": "NH",
            "postal_code": "034314235",
            "country_code": "US",
            "telephone_number": "603-556-7101",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CENTER STATE WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-24",
        "last_updated": "2019-06-24",
        "status": "A",
        "authorized_official_last_name": "HOWARD",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "603-556-7101",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Concord, NH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2019; 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.