Ignite Wellness Clinic PLLC

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

Legal business name

IGNITE WELLNESS CLINIC PLLC

Practice address

4633 Brambleton Ave Ste 200
Roanoke, VA 24018-3410

Phone

(540) 345-3556

NPI assigned

Jan 18, 2022

Last updated

Jan 18, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

James FarmerNPI 1013988161

Title

President

Phone

(540) 345-3556

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA2 enrollments

Enrollment records 2

Practitioners 3

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.

• James Mastin Farmer, M.D.

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Roanoke, VA
  • NPI 1013988161
  Medicare reassignment Care Compare group NPD Authorized official
• Sheila Farmer

  • Certified Registered Nurse Anesthetist
  • Salem, VA
  • NPI 1477519387
  Medicare reassignment Care Compare group NPD
• Brian R Ingram, PA

  • Physician Assistant
  • Edgewood, NM
  • NPI 1700368495

  VA

  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1642464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642464000000",
    "number": "1871244103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8310",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240140310",
            "telephone_number": "540-345-3556",
            "fax_number": "540-342-2193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4633 BRAMBLETON AVE STE 200",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240183410",
            "telephone_number": "540-345-3556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IGNITE WELLNESS CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-18",
        "last_updated": "2022-01-18",
        "certification_date": "2022-01-18",
        "status": "A",
        "authorized_official_last_name": "FARMER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "540-345-3556"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anne K Ickes, DO
• Michelle Ann Ickes, PH.D.
• Idoctorben LLC
• Susanti Rahaju Ie, MD
• Obafemi Ayoola Ifelowo, MD
• Emeka Ikeakanam, DO
• Image Guided Pain Management, P.C. (RAYUS Radiology)
• Image Guided Therapeutics, PC
• Khursheed Imam, MD
• Naiyer Imam, MD

• Orthopaedic Surgery Physician in Roanoke, VA
• Providers in Roanoke, VA by specialty
• Orthopaedic Surgery Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2022; 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.