NPIMap

Organization Active NPI

Wellcare Medical, LLC

  • Internal Medicine Physician
  • Muncie, IN
National Provider Identifier
1780948646
Registry record updated Jun 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
010713125A Issued in IN
Legal business name
WELLCARE MEDICAL, LLC
Practice address
1910 W Royale Dr
Muncie, IN 47304-2264
Phone
(765) 289-1011
Fax
(765) 289-3024
NPI assigned
Jun 26, 2012
Last updated
Jun 26, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2012

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

Authorized official

Name
Caroline Collins, M.D.
Title
President
Phone
(765) 289-1011

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 010713125A IN Primary

Addresses

Primary practice location

1910 W Royale Dr
Muncie, IN 47304-2264

Mailing address

1910 W Royale Dr
Muncie, IN 47304-2264
Phone (765) 289-1011

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

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": "1340668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340668800000",
    "number": "1780948646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1910 W ROYALE DR",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473042264",
            "telephone_number": "765-289-1011",
            "fax_number": "765-289-3024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1910 W ROYALE DR",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473042264",
            "telephone_number": "765-289-1011",
            "fax_number": "765-289-3024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLCARE MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-26",
        "last_updated": "2012-06-26",
        "status": "A",
        "authorized_official_last_name": "COLLINS",
        "authorized_official_first_name": "CAROLINE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "765-289-1011",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "010713125A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Muncie, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.