NPIMap

Organization Active NPI

Internal Medicine & Pediatrics Wellness Center

  • Internal Medicine Physician
  • Crystal River, FL
National Provider Identifier
1992825145
Registry record updated Jun 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME93743 Issued in FL
Legal business name
INTERNAL MEDICINE & PEDIATRICS WELLNESS CENTER
Practice address
6038 W. Nordling Loop
Crystal River, FL 34429
Phone
(352) 795-2459
Fax
(352) 795-4322
NPI assigned
Mar 30, 2007
Last updated
Jun 5, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2014

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

Authorized official

Name
Mrs. Carlene A. Wilson, MDNPI 1407850365
Title
Owner/Physician
Phone
(352) 795-2459

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)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X ME93743 FL Primary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X ME93743 FL

Addresses

Primary practice location

6038 W. Nordling Loop
Crystal River, FL 34429

Mailing address

PO Box 2012
Lecanto, FL 34460
Phone (352) 795-2459

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060113000721 FL Part B Supplier - Clinic/Group Practice 9739103920 Receives reassigned benefits from 13 practitioners
Practice locations: Crystal River, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D1048468Internal Medicine & Pediatrics Wellness Center6038 W Nordling Loop, Crystal River, FL 34429Certificate of waiverDec 1, 2027

National Provider Directory

National Provider Directory

Locations

6038 W Nordling Loop
Crystal River, FL 34429
Phone (352) 563-5070

934 N Suncoast Blvd
Crystal River, FL 34429
Phone (352) 794-6208

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401926400000",
    "number": "1992825145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2012",
            "city": "LECANTO",
            "state": "FL",
            "postal_code": "34460",
            "telephone_number": "352-795-2459",
            "fax_number": "352-795-4322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6038 W. NORDLING LOOP",
            "city": "CRYSTAL RIVER",
            "state": "FL",
            "postal_code": "34429",
            "telephone_number": "352-795-2459",
            "fax_number": "352-795-4322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNAL MEDICINE & PEDIATRICS WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-30",
        "last_updated": "2014-06-05",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "CARLENE",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "352-795-2459",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME93743",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME93743",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crystal River, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.