NPIMap

Organization Active NPI

Trinity Wellness Center of Wilmington Inc

  • Psychiatry Physician
  • Wilmington, NC
National Provider Identifier
1841382173
Registry record updated Jun 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
9600112 Issued in NC
Legal business name
TRINITY WELLNESS CENTER OF WILMINGTON INC
Practice address
1907 S 17TH St
Suite 1
Wilmington, NC 28401-6626
Phone
(910) 343-8424
Fax
(910) 343-6989
NPI assigned
Sep 28, 2006
Last updated
Jun 4, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2024

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

Authorized official

Name
Marisa Martell
Title
Credentialling Manager
Phone
(904) 420-7343

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X 9600112 NC Primary

Addresses

Primary practice location

1907 S 17TH St
Suite 1
Wilmington, NC 28401-6626

Mailing address

1907 S 17TH St
Suite 1
Wilmington, NC 28401-6626
Phone (910) 343-8424

Other identifiers 2

IdentifierTypeStateIssuer
6005578MedicaidNC
5900768MedicaidNC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050725000425 NC Part B Supplier - Clinic/Group Practice 6002843752 Receives reassigned benefits from 15 practitioners
Practice locations: Hillsborough, NC; Leland, NC; Wilmington, NC

National Provider Directory

National Provider Directory

Locations

1000 Corporate Dr
Ste 301
Hillsborough, NC 27278
Phone (910) 343-8424

2528 Castle Hayne Rd
Ste 5
Wilmington, NC 28401
Phone 91034384242

7741 Market St
Ste H
Wilmington, NC 28411
Phone (910) 343-8424

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717459200000",
    "number": "1841382173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1907 S 17TH ST",
            "address_2": "SUITE 1",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284016626",
            "telephone_number": "910-343-8424",
            "fax_number": "910-343-6989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1907 S 17TH ST",
            "address_2": "SUITE 1",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284016626",
            "telephone_number": "910-343-8424",
            "fax_number": "910-343-6989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRINITY WELLNESS CENTER OF WILMINGTON INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2024-06-04",
        "certification_date": "2024-06-04",
        "status": "A",
        "authorized_official_last_name": "MARTELL",
        "authorized_official_first_name": "MARISA",
        "authorized_official_title_or_position": "CREDENTIALLING MANAGER",
        "authorized_official_telephone_number": "904-420-7343"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NC",
            "license": "9600112",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6005578",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5900768",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2024; 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.