NPIMap

Organization Active NPI

Bain Complete Wellness LLC

  • Family Medicine Physician
  • Tampa, FL
National Provider Identifier
1821491168
Registry record updated Oct 1, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BAIN COMPLETE WELLNESS LLC
Practice address
10311 Cross Creek Blvd
Suite E
Tampa, FL 33647-2989
Phone
(813) 907-9898
Fax
(813) 907-0220
NPI assigned
Oct 1, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2014

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

Authorized official

Name
Ms. Susanne F Witt
Title
VP, Operations
Phone
(813) 574-2460

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X

Addresses

Primary practice location

10311 Cross Creek Blvd
Suite E
Tampa, FL 33647-2989

Mailing address

1868 Highland Oaks Blvd Ste B
Lutz, FL 33559-7413
Phone (813) 574-2460

National Provider Directory

National Provider Directory
Tax ID family
Bain Complete Wellness LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1412121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412121600000",
    "number": "1821491168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1868 HIGHLAND OAKS BLVD STE B",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335597413",
            "telephone_number": "813-574-2460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10311 CROSS CREEK BLVD",
            "address_2": "SUITE E",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336472989",
            "telephone_number": "813-907-9898",
            "fax_number": "813-907-0220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAIN COMPLETE WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-01",
        "last_updated": "2014-10-01",
        "status": "A",
        "authorized_official_last_name": "WITT",
        "authorized_official_first_name": "SUSANNE",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "VP, OPERATIONS",
        "authorized_official_telephone_number": "813-574-2460",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2014; 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.