Active NPI
Gary D Wines, D.C.
- Chiropractor
- Beaumont, CA
National Provider Identifier
1760487268
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- DC015440
- Practice address
- 1074 Beaumont Ave
Beaumont, CA 92223-1833 - Phone
- (951) 845-6456
- Fax
- (951) 845-7485
- NPI assigned
- Jun 20, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | DC015440 | CA | Primary |
Addresses
Primary practice location
1074 Beaumont Ave
Beaumont, CA 92223-1833
Mailing address
1074 Beaumont Ave
Beaumont, CA 92223-1833
Phone (951) 845-6456
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DC015440 | Other | CA | BLUE SHIELD |
| 4294325 | Other | CA | AETNA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110408000592 | CA | Practitioner - Chiropractic | 8921282328 | Practice locations: Beaumont, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Los Angeles College of Chiropractic, 1982
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
1074 Beaumont Ave
Beaumont, CA 92223-1833
Phone (951) 845-6456
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15440 | CA | MD | Marriage & Family Therapist |
| DC015440 | CA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1312243200000",
"number": "1760487268",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1074 BEAUMONT AVE",
"city": "BEAUMONT",
"state": "CA",
"postal_code": "922231833",
"telephone_number": "951-845-6456",
"fax_number": "951-845-7485"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1074 BEAUMONT AVE",
"city": "BEAUMONT",
"state": "CA",
"postal_code": "922231833",
"telephone_number": "951-845-6456",
"fax_number": "951-845-7485"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WINES",
"first_name": "GARY",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-06-20",
"last_updated": "2011-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CA",
"license": "DC015440",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "DC015440",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4294325",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Beaumont, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.