Wellendorf ENT, P.C.

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

30594 Issued in IA

Legal business name

WELLENDORF ENT, P.C.

Practice address

405 S Clark St
Suite 215
Carroll, IA 51401-3065

Phone

(712) 792-4368

Fax

(712) 792-2056

NPI assigned

May 10, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Tracey G Wellendorf, M.D.NPI 1528057387

Title

President

Phone

(712) 792-4368

Specialties & licenses 1

Addresses

Other identifiers 5

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IA

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.236

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tracey G Wellendorf, MD

  • Otolaryngology Physician
  • Carroll, IA
  • NPI 1528057387
  Medicare reassignment Authorized official
• Jessica Leeds, MSN. ARNP, FNP-BC

  • Otolaryngology Physician
  • Carroll, IA
  • NPI 1750089058
  NPD
• Vivian Dianne Chance, ARNP

  • Family Nurse Practitioner
  • Carroll, IA
  • NPI 1396071015
  NPD (past)
• Ronald A Cheney, D.O.

  • Surgery Physician
  • Lake City, IA
  • NPI 1225089535
  NPD (past)
• Josh A Smith, D.O.

  • Surgery Physician
  • Carroll, IA
  • NPI 1639127368
  NPD (past)
• Virginia Ann Uhlenkamp, ARNP

  • Family Nurse Practitioner
  • Carroll, IA
  • NPI 1912188780
  NPD (past)
• Marc L Miller, DO

  • Surgery Physician
  • Columbia, MO
  • NPI 1023061413
  NPD (past)
• G Patrick Riedmann Jr, PA-C

  • Physician Assistant
  • Sioux Falls, SD
  • NPI 1750471058
  NPD (past)

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

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553558400000",
    "number": "1740494244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 766",
            "city": "CARROLL",
            "state": "IA",
            "postal_code": "514010766",
            "telephone_number": "712-792-4368",
            "fax_number": "712-792-4351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 S CLARK ST",
            "address_2": "SUITE 215",
            "city": "CARROLL",
            "state": "IA",
            "postal_code": "514013065",
            "telephone_number": "712-792-4368",
            "fax_number": "712-792-2056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLENDORF ENT, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-10",
        "last_updated": "2019-03-26",
        "status": "A",
        "authorized_official_last_name": "WELLENDORF",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "712-792-4368",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": "IA",
            "license": "30594",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2124032",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1124032",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5124032",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3124032",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6124032",
            "state": "IA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jwellendorf@wellendorfent.com",
            "affiliation": "N",
            "address_1": "1124 W 20th St",
            "city": "Carroll",
            "state": "IA",
            "country_code": "US",
            "postal_code": "514013357",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Walmart Inc.
• Luann Walsh
• Rosemary C Watchorn, MS, RD, LD
• Katrina (Tina) K Wederquist Zanders, MS, LMSW
• Dorinda Wehde, MS, CADC
• Tracey G Wellendorf, MD
• Catherine A Wernimont, RD LD
• Matthew Thomas Wessling, ARNP
• Kellie A Westercamp, RD
• Western Iowa Sleep Inc

• Otolaryngology Physician in Carroll, IA
• Providers in Carroll, IA by specialty
• Otolaryngology Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 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.