Active NPI
Wendell Lee Wells, M.D.
- Family Medicine Physician
- Burley, ID
National Provider Identifier
1902848922
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- M4248
- Practice address
- 1501 Hiland Ave
Suite L-1
Burley, ID 83318-2682 - Phone
- (208) 678-8899
- NPI assigned
- Jun 12, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | M4248 | ID | Primary |
Addresses
Primary practice location
1501 Hiland Ave
Suite L-1
Burley, ID 83318-2682
Mailing address
1501 Hiland Ave
Suite L-1
Burley, ID 83318-2682
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000010004744 | Other | ID | BLUE SHIELD |
| 002556300 | Medicaid | ID | |
| 4248-1 | Other | ID | BLUE CROSS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M4248 | ID | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150070400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1539820800000",
"number": "1902848922",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1501 HILAND AVE",
"address_2": "SUITE L-1",
"city": "BURLEY",
"state": "ID",
"postal_code": "833182682"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1501 HILAND AVE",
"address_2": "SUITE L-1",
"city": "BURLEY",
"state": "ID",
"postal_code": "833182682",
"telephone_number": "208-678-8899"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WELLS",
"first_name": "WENDELL",
"middle_name": "LEE",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-12",
"last_updated": "2018-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "ID",
"license": "M4248",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "000010004744",
"state": "ID"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "002556300",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "4248-1",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Burley, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.