NPIMap

Organization Active NPI

Community Wellness Medical Associates a PC

  • Family Medicine Physician
  • Danville, KY
National Provider Identifier
1952995615
Registry record updated Apr 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
COMMUNITY WELLNESS MEDICAL ASSOCIATES A PC
Practice address
304 S 4TH St Ste 301
Danville, KY 40422-2081
Phone
(650) 722-2611
NPI assigned
Feb 23, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2025

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

Authorized official

Name
Michael Tinamisan CatausanNPI 1932326071
Title
MD
Phone
(913) 827-7273

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 Primary

Addresses

Primary practice location

304 S 4TH St Ste 301
Danville, KY 40422-2081

Mailing address

1821 S Bascom Ave # 383
Campbell, CA 95008-2309

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220513000682 CA Part B Supplier - Clinic/Group Practice 0042697088 Receives reassigned benefits from 4 practitioners
Practice locations: Campbell, CA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

1372 Peachtree St NE
Ste 130
Atlanta, GA 30309

1355 Lebanon Rd
Danville, KY 40422

304 S 4th St
Ste 30
Danville, KY 40422

Practitioners & affiliated clinicians

Practitioners 9

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": "1614038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745971200000",
    "number": "1952995615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1821 S BASCOM AVE # 383",
            "city": "CAMPBELL",
            "state": "CA",
            "postal_code": "950082309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 S 4TH ST STE 301",
            "city": "DANVILLE",
            "state": "KY",
            "postal_code": "404222081",
            "telephone_number": "650-722-2611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY WELLNESS MEDICAL ASSOCIATES A PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-23",
        "last_updated": "2025-04-30",
        "certification_date": "2025-04-08",
        "status": "A",
        "authorized_official_last_name": "CATAUSAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "TINAMISAN",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "913-827-7273"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Danville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2025; 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.