Organization Active NPI

Wellcare of BX Medical PC

  • Family Medicine Physician
  • Bronx, NY
National Provider Identifier
1851848618
Registry record updated Sep 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
228243 Issued in NY
Legal business name
WELLCARE OF BX MEDICAL PC
Practice address
2336 Grand Concourse
Bronx, NY 10458-6903
Phone
(718) 220-0439
Fax
(718) 933-2914
NPI assigned
Sep 8, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2016

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

Authorized official

Name
Dr. Svetlana Khandros, D.ONPI 1871578872
Title
Owner
Phone
(718) 220-0439

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 228243 NY Primary

Addresses

Primary practice location

2336 Grand Concourse
Bronx, NY 10458-6903

Mailing address

2336 Grand Concourse
Bronx, NY 10458-6903
Phone (718) 220-0439

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180611001867 NY Part B Supplier - Clinic/Group Practice 5890040166 Receives reassigned benefits from 17 practitioners
Practice locations: Bronx, NY

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
33D2275534Wellcare of BX Medical PC2336 Grand Concourse, Bronx, NY 10458Certificate of waiverJan 23, 2027

National Provider Directory

National Provider Directory

Locations

326 E 149th St
Fl 1
Bronx, NY 10451

2336 Grand Concourse
Bronx, NY 10458
Phone (718) 220-0439

2336 Grand Concourse
#1A
Bronx, NY 10458

Practitioners & affiliated clinicians

Practitioners 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1473292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473292800000",
    "number": "1851848618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2336 GRAND CONCOURSE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104586903",
            "telephone_number": "718-220-0439",
            "fax_number": "718-933-2914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2336 GRAND CONCOURSE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104586903",
            "telephone_number": "718-220-0439",
            "fax_number": "718-933-2914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLCARE OF BX MEDICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-08",
        "last_updated": "2016-09-08",
        "status": "A",
        "authorized_official_last_name": "KHANDROS",
        "authorized_official_first_name": "SVETLANA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-220-0439",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "228243",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.