Organization Active NPI

MW Wellness XV LLC

  • Family Medicine Physician
  • Brookfield, CT
National Provider Identifier
1780344515
Registry record updated Jun 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MW WELLNESS XV LLC
Practice address
67 Federal Rd Ste 100
Brookfield, CT 06804-2539
Phone
(813) 228-6334
NPI assigned
Dec 21, 2021
Last updated
Jun 26, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2023

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

Authorized official

Name
Jodi Despoy
Title
Manager
Phone
(813) 228-6334

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Obesity Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RB0002X

Addresses

Primary practice location

67 Federal Rd Ste 100
Brookfield, CT 06804-2539

Mailing address

509 S Hyde Park Ave
Tampa, FL 33606-2266
Phone (813) 228-6334

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
07D2247141MW Wellness XV, LLC67 Federal Rd, BLDG B, Ste 100, Brookfield, CT 06804Certificate of waiverJan 3, 2028

National Provider Directory

National Provider Directory

Locations

67 Federal Rd
Brookfield, CT 06804

67 Federal Rd
Bldg B
Brookfield, CT 06804

67 Federal Rd
Ste 109B
Brookfield, CT 06804

Practitioners & affiliated clinicians

Practitioners 5

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": "1640044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687737600000",
    "number": "1780344515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 S HYDE PARK AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336062266",
            "telephone_number": "813-228-6334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67 FEDERAL RD STE 100",
            "city": "BROOKFIELD",
            "state": "CT",
            "postal_code": "068042539",
            "telephone_number": "813-228-6334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MW WELLNESS XV LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-21",
        "last_updated": "2023-06-26",
        "certification_date": "2023-06-26",
        "status": "A",
        "authorized_official_last_name": "DESPOY",
        "authorized_official_first_name": "JODI",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "813-228-6334"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RB0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Obesity Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookfield, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.

Verify at the official NPI Registry.