Active NPI
Ketamine Wellness Institute, LLC
- Pain Medicine (Anesthesiology) Physician
- Chapel Hill, NC
National Provider Identifier
1740066216
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pain Medicine (Anesthesiology) Physician
- Legal business name
- 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
- Organization subpart
- No
NPPES NPI Registry
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Pain Medicine (Anesthesiology) Physician | 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
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AK
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230921003948 | AK | Part B Supplier - Clinic/Group Practice | 4789038928 |
Receives reassigned benefits from 6 practitioners Practice locations: Anchorage, AK |
National Provider Directory
National Provider DirectoryLocations
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.
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.