Active NPI
Wellspring Clinic LLC
- Physical Medicine & Rehabilitation Physician
- Bel Air, MD
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- License
- D63924
- Legal business name
- WELLSPRING CLINIC LLC
- Practice address
- 2012 S Tollgate Rd
Suite 206
Bel Air, MD 21015-5900 - Phone
- (443) 371-9750
- NPI assigned
- Aug 30, 2016
- Last updated
- Jul 12, 2019
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Nkiruka Arene, MD
- Title
- Physician
- Phone
- (443) 371-9750
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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | D63924 | MD | |
| Physical Medicine & Rehabilitation Physician | 208100000X | D63924 | MD | Primary |
Addresses
Primary practice location
2012 S Tollgate Rd
Suite 206
Bel Air, MD 21015-5900
Mailing address
2012 S Tollgate Rd Ste 207
Bel Air, MD 21015-5902
Phone (443) 977-9180
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 875800000 | Medicaid | MD |
National Provider Directory
National Provider Directory- Tax ID family
- Wellspring Clinic LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Medical Specialty Clinic/Center
- Bel Air, MD
- NPI 1154788818
Practitioners & affiliated clinicians
Practitioners 1
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.
-
- Physical Medicine & Rehabilitation Physician
- Bel Air, MD
- NPI 1477517332
Family Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1472515200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1562889600000",
"number": "1962958926",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2012 S TOLLGATE RD STE 207",
"city": "BEL AIR",
"state": "MD",
"postal_code": "210155902",
"telephone_number": "443-977-9180"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2012 S TOLLGATE RD",
"address_2": "SUITE 206",
"city": "BEL AIR",
"state": "MD",
"postal_code": "210155900",
"telephone_number": "443-371-9750"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WELLSPRING CLINIC LLC",
"organizational_subpart": "NO",
"enumeration_date": "2016-08-30",
"last_updated": "2019-07-12",
"status": "A",
"authorized_official_last_name": "ARENE",
"authorized_official_first_name": "NKIRUKA",
"authorized_official_title_or_position": "PHYSICIAN",
"authorized_official_telephone_number": "443-371-9750",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": "MD",
"license": "D63924",
"primary": false
},
{
"code": "208100000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physical Medicine & Rehabilitation",
"state": "MD",
"license": "D63924",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "875800000",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bel Air, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.