NPIMap

Organization Active NPI

Ketamine Wellness Institute, LLC

  • Pain Medicine (Anesthesiology) Physician
  • Chapel Hill, NC
National Provider Identifier
1740066216
Registry record updated Mar 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
Legal business name
KETAMINE WELLNESS INSTITUTE, LLC
Doing business as
Ketamine Wellness Institute, LLC
Practice address
5915 Farrington Rd Ste 105
Chapel Hill, NC 27517-9900
Phone
(907) 885-0206
Fax
(907) 600-5089
NPI assigned
Aug 31, 2023
Last updated
Mar 22, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2024

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

Authorized official

Name
Dr. Bilal Lateef, MD
Title
Medical Director
Phone
(919) 943-9122

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LP2900X Primary

Addresses

Primary practice location

5915 Farrington Rd Ste 105
Chapel Hill, NC 27517-9900

Mailing address

1335 Cappoquin Way
Burlington, NC 27215-9396
Phone (907) 885-0206

Other names 1

  • Ketamine Wellness Institute, LLC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230921003948 AK Part B Supplier - Clinic/Group Practice 4789038928 Receives reassigned benefits from 6 practitioners
Practice locations: Anchorage, AK

National Provider Directory

National Provider Directory

Locations

3210 Denali St
Ste 4
Anchorage, AK 99503
Phone (907) 891-7877

4050 Lake Otis Pkwy
Ste 208
Anchorage, AK 99508
Phone (907) 317-1331

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1693440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711065600000",
    "number": "1740066216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1335 CAPPOQUIN WAY",
            "city": "BURLINGTON",
            "state": "NC",
            "postal_code": "272159396",
            "telephone_number": "907-885-0206",
            "fax_number": "907-600-5089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5915 FARRINGTON RD STE 105",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275179900",
            "telephone_number": "907-885-0206",
            "fax_number": "907-600-5089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETAMINE WELLNESS INSTITUTE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-31",
        "last_updated": "2024-03-22",
        "certification_date": "2024-03-22",
        "status": "A",
        "authorized_official_last_name": "LATEEF",
        "authorized_official_first_name": "BILAL",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "919-943-9122",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ketamine Wellness Institute, LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ketamine Wellness Institute, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chapel Hill, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2024; 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.