Organization Active NPI

Performance Wellness Centers, LLC

  • Sports Physician Chiropractor
  • Austin, TX
National Provider Identifier
1982818647
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Physician ChiropractorTaxonomy code 111NS0005X
Legal business name
PERFORMANCE WELLNESS CENTERS, LLC
Practice address
6500 North Mopac Expressway BLD 3
Suite 3101
Austin, TX 78731
Phone
(512) 491-7772
Fax
(512) 339-6806
NPI assigned
May 10, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Brandie L Leach, DC
Title
Owner
Phone
(512) 491-7772

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Physician ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NS0005X Primary

Addresses

Primary practice location

6500 North Mopac Expressway BLD 3
Suite 3101
Austin, TX 78731

Mailing address

6500 North Mopac Expressway BLD 3
Suite 3101
Austin, TX 78731
Phone (512) 491-7772

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080404000125 TX Part B Supplier - Clinic/Group Practice 7315024163 Receives reassigned benefits from 1 practitioner
Practice locations: Austin, TX

National Provider Directory

National Provider Directory

Locations

8100 Shoal Creek Blvd
Ste 110
Austin, TX 78757
Phone (512) 491-7772

6500 N Mopac Expy
Ste 3101
Austin, TX 78731
Phone (512) 491-7772

19912 Highway 71 W
Spicewood, TX 78669
Phone (572) 491-7772

Practitioners & affiliated clinicians

Practitioners 2

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": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1982818647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6500 NORTH MOPAC EXPRESSWAY BLD 3",
            "address_2": "SUITE 3101",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "78731",
            "telephone_number": "512-491-7772",
            "fax_number": "512-339-6806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6500 NORTH MOPAC EXPRESSWAY BLD 3",
            "address_2": "SUITE 3101",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "78731",
            "telephone_number": "512-491-7772",
            "fax_number": "512-339-6806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERFORMANCE WELLNESS CENTERS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LEACH",
        "authorized_official_first_name": "BRANDIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "512-491-7772",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Sports Physician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Austin, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.