INDIAN WELLS MEDICAL CENTER (NPI# 1548288574) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548288574 |
| Entity Type | Organization |
| Organization Name | INDIAN WELLS MEDICAL CENTER |
| Other Organization Name | SPENCER MEDICAL GROUP |
| Practice Address |
74976 Us Highway 111 Indian Wells CA 92210-7117 |
| Mailing Address |
74976 Highway 111 Indian Wells CA 92210 |
| Practice Telephone | 7605684544 |
| Practice Fax Number | 7605684555 |
| Mailing Telephone | 7605684544 |
| Mailing Fax Number | 7605684555 |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2008-03-15 |
| Authorized Official Name | DR. CORVIN KELLY (DIRECTOR/OFFICER) |
| Authorized Official Telephone | 7605684544 |
| Authorized Official Credential | D.C. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 111N00000X | Chiropractor | DC26074 | CA | Chiropractic Providers |
| N | 207R00000X | Internal Medicine | C29564 | CA | Allopathic & Osteopathic Physicians |
| N | 225100000X | Physical Therapist | PT19355 | CA | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| N | 208D00000X | General Practice | A28654 | CA | Allopathic & Osteopathic Physicians |
| Y | 207Q00000X | Family Medicine | A83821 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | BLUE SHIELD TRI-CARE WEST | ZZZ13978Z | 01 |
| CA | BLUE SHIELD PROVIDER # | ZZZ13979Z | 01 |
| Other Name | Type Code |
|---|---|
| SPENCER MEDICAL GROUP | Former Legal Business Name - Organization |
| Street Address |
74976 US HIGHWAY 111 |
| City | INDIAN WELLS |
| State | CA |
| Zip Code | 92210-7117 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134120058 | Corvin Kelly | Chiropractor | 74976 Us Highway 111, Indian Wells, CA 92210-7117 | 2005-08-02 |
| 1659729358 | South West Tmj Speciality Group | Dentist | 74976 Us Highway 111, Indian Wells, CA 92210-7117 | 2016-06-03 |
| 1831351998 | Kelly Chiropractic Inc | Chiropractor | 74976 Us Highway 111, Indian Wells, CA 92210-7117 | 2008-06-30 |
| 1003943259 | Morton Zebrack | General Practice | 74976 Us Highway 111, Indian Wells, CA 92210-7117 | 2007-02-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750579348 | Linda Mak, Md, Inc. | Dermatology | 74-900 Hwy 111, Ste 212, Indian Wells, CA 92210 | 2007-10-09 |
| 1639372162 | Gary R Smith | Chiropractor | 74-967 Hwy 111, Indian Wells Chiropractic Clinic, Indian Wells, CA 92210 | 2007-06-11 |
| 1477696813 | Richard Stephen Donley | Chiropractor | 74967 Highway 111, Indian Wells, CA 92210 | 2007-02-15 |
| 1689746125 | Frank Warren Gustafson | Physical Therapist | 45240 Club Drive, Indian Wells, CA 92210 | 2006-11-13 |
| 1891899373 | Matthew F Gutowicz Jr. | Radiology | 74785 Highway 111 Suite V101 Wall St West Bldg, Indian Wells, CA 92210 | 2006-09-12 |
| 1407959455 | Emergency Physicians Medical Group Inc | Emergency Medicine | 74785 Highway 111, Suite 100, Indian Wells, CA 92210 | 2006-09-06 |
| 1033169339 | Adam James Brochert | Radiology | 74785 Us Highway 111 Ste 101, Indian Wells, CA 92210 | 2006-05-10 |
| 1801181961 | Executive Urgent Care of Indian Wells | Clinic/Center | 74785 Highway 111, Suite 100, Indian Wells, CA 92210 | 2011-06-16 |
| 1801093844 | Frank Conyngham Crawford II | Dentist | 74-900 Hwy 111, Suite 210, Indian Wells, CA 92210 | 2007-07-02 |
| 1942358320 | Richard Vandyke Packard | Optometrist | 74927 Us Highway 111, Indian Wells, CA 92210 | 2007-01-08 |
| Find all providers in zip 92210 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
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| 1205435864 | Montana Affinity LLC | Family Medicine | 820 N Mountain Ave Ste 103, Upland, CA 91786-4163 | 2020-10-23 |
| 1861091126 | Silvia Diego Md Inc A Professional Medical Corp | Family Medicine | 1317 Oakdale Rd Ste 100, Modesto, CA 95355-3362 | 2020-10-19 |
| 1245838879 | Lalaine Talagtag Smith | Family Medicine | 919 Mariner Dr Apt C, Mountain View, CA 94043-3372 | 2020-10-15 |
| 1417554023 | Hameed A. Khan, M.d., Inc. | Family Medicine | 3655 Lomita Blvd Ste 421, Torrance, CA 90505-1934 | 2020-10-06 |
| 1073120085 | Garrison Family Medical Group Inc | Family Medicine | 41210 11th St W Ste C, Palmdale, CA 93551-1447 | 2020-09-24 |
| Find all providers with the same taxonomy | ||||
| City | INDIAN WELLS |
| Zip Code | 92210 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.