NPIMap

Organization Active NPI

Restoration and Wellness LLC

  • Adult Mental Health Clinic/Center
  • Fort Washington, PA
National Provider Identifier
1770172033
Registry record updated Jul 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
Legal business name
RESTORATION AND WELLNESS LLC
Practice address
223 Summit Ave
Fort Washington, PA 19034-1525
Phone
(844) 448-5872
Fax
(267) 996-3983
NPI assigned
Jan 12, 2021
Last updated
Jul 8, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2021

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

Authorized official

Name
Matthew McCullough, CRNANPI 1629135538
Title
SVP, Cco
Phone
(609) 828-8061

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
Adult Mental Health Clinic/Center 261QM0850X Primary

Addresses

Primary practice location

223 Summit Ave
Fort Washington, PA 19034-1525

Mailing address

223 Summit Ave
Fort Washington, PA 19034-1525
Phone (844) 448-5872

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address documents@ucarepartners.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221003000684 PA Part B Supplier - Clinic/Group Practice 7618353426 Receives reassigned benefits from 7 practitioners
Practice locations: Fort Washington, PA; Royersford, PA

National Provider Directory

National Provider Directory

Locations

223 Summit Ave
Ft Washington, PA 19034
Phone (844) 448-5672

Interoperability endpoints

  • Direct secure messaging: documents@ucarepartners.com

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1610409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625702400000",
    "number": "1770172033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "223 SUMMIT AVE",
            "city": "FORT WASHINGTON",
            "state": "PA",
            "postal_code": "190341525",
            "telephone_number": "844-448-5872",
            "fax_number": "267-996-3983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "223 SUMMIT AVE",
            "city": "FORT WASHINGTON",
            "state": "PA",
            "postal_code": "190341525",
            "telephone_number": "844-448-5872",
            "fax_number": "267-996-3983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORATION AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-12",
        "last_updated": "2021-07-08",
        "certification_date": "2021-07-08",
        "status": "A",
        "authorized_official_last_name": "MCCULLOUGH",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "SVP, CCO",
        "authorized_official_telephone_number": "609-828-8061",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "documents@ucarepartners.com",
            "affiliation": "N",
            "endpointDescription": "secure document repository",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "223 Summit Ave",
            "city": "Fort Washington",
            "state": "PA",
            "country_code": "US",
            "postal_code": "190341525",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fort Washington, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2021; 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.