NPIMap

Organization Active NPI

Wellspring Clinic LLC

  • Physical Medicine & Rehabilitation Physician
  • Bel Air, MD
National Provider Identifier
1831443787
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
WELLSPRING CLINIC LLC
Practice address
2012 S Tollgate Rd Ste 207
Bel Air, MD 21015-5902
Phone
(443) 371-9750
Fax
(443) 371-9751
NPI assigned
Oct 30, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Authorized official

Name
Nkiruka Arene, M.D.NPI 1477517332
Title
Director
Phone
(443) 371-9750

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 5

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X Primary
Brain Injury Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P0301X
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P2900X
Medical Specialty Clinic/Center 261QM2500X D63924 MD

Addresses

Primary practice location

2012 S Tollgate Rd Ste 207
Bel Air, MD 21015-5902

Mailing address

2012 S Tollgate Rd Ste 207
Bel Air, MD 21015-5902
Phone (443) 371-9750

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130321000072 MD Part B Supplier - Clinic/Group Practice 7113162264 Receives reassigned benefits from 4 practitioners
Practice locations: Bel Air, MD
O20170118000597 MD DME Supplier - Physician - General Practice 7113162264 Practice locations: Bel Air, MD

National Provider Directory

National Provider Directory

Locations

2012 S Tollgate Rd
Ste 206
Bel Air, MD 21015
Phone (443) 371-9750

2012 S Tollgate Rd
Ste 207
Bel Air, MD 21015
Phone (443) 371-9750

Practitioners & affiliated clinicians

Practitioners 4

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": "1351555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1831443787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2012 S TOLLGATE RD STE 207",
            "city": "BEL AIR",
            "state": "MD",
            "postal_code": "210155902",
            "telephone_number": "443-371-9750",
            "fax_number": "443-371-9751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2012 S TOLLGATE RD STE 207",
            "city": "BEL AIR",
            "state": "MD",
            "postal_code": "210155902",
            "telephone_number": "443-371-9750",
            "fax_number": "443-371-9751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSPRING CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-30",
        "last_updated": "2023-11-27",
        "certification_date": "2023-11-27",
        "status": "A",
        "authorized_official_last_name": "ARENE",
        "authorized_official_first_name": "NKIRUKA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "443-371-9750",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2081P0301X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Brain Injury Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "MD",
            "license": "D63924",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bel Air, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; 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.