Internal Medicine & Pediatrics Wellness Center
Organization Active NPI Internal Medicine Physician · Crystal River, FL
NPI 1992825145 · NPPES record last updated Jun 5, 2014
Key facts
- NPI
- 1992825145
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- ME93743 (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
- Organization subpart
- No
Authorized official
- Name
- Mrs. Carlene A. Wilson, MD
- Title
- Owner/Physician
- Phone
- (352) 795-2459
Subparts reporting this organization as parent 1
Practitioners 15
-
Carlene A. Wilson, M.D.
-
Charles F. Brinegar Jr., ARNP
-
Jennifer Hegarty, APRN
-
Angela Marie Johnson, APRN
-
Mary-Ellen Macdonald, FNP
-
Carolina Cunningham, ARNP
-
Melissa J Medlin, ARNP
-
Traci Marie Miramontes, APRN
-
Valorea Williams, APRN
-
Joseph James Starnes, PA-C
-
Hunter Cooper, PHYSICIAN ASSISTANT
-
Lauralee Woods-Brown, ARNP 1437322
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 10D1048468 | Internal Medicine & Pediatrics Wellness Center | Certificate of waiver | Dec 1, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060113000721 | FL | Part B Supplier - Clinic/Group Practice | 9739103920 |
Receives reassigned benefits from 13 practitioners Practice locations: Crystal River, FL |
National Provider Directory
Locations
934 N Suncoast Blvd
Crystal River, FL 34429
Phone (352) 794-6208
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | ME93743 | FL | Yes |
| Pediatrics Physician |
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
Other providers in Crystal River, FL
- Gail E Huecker
- Karelle Verone Hylton
- Hyperbaric Guru, LLC
- Jessica Hyppolite
- Impact Counseling and Consulting LLC
- Ira Fialko DO PA
- Irven Chiropractic Health Center,Inc.
- Nancy I Irven
- David Irvine
- Natasha Yvonne Jackson-Cannon
All providers in Crystal River, FL · Internal Medicine Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 5, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.