Ideal Wellness Llc is a medicare enrolled "Clinic/center - Multi-specialty" provider in Baltimore, Maryland. Their current practice location is
3914 Hickory Ave, Baltimore, Maryland. You can reach out to their office (for appointments etc.) via phone at
(410) 916-6888.
Ideal Wellness Llc is licensed to practice in * (Not Available) (license number ) and it also participates in the medicare program. Ideal Wellness Llc
is enrolled with medicare and should accept medicare assignments and since they are enrolled in medicare, they may order Medicare Part D Prescription drugs, if eligible. The facility's NPI Number is 1477365849.
Healthcare Provider's Profile
| Full Name | Ideal Wellness Llc |
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| Type | Facility |
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| Speciality | Clinic/center - Multi-specialty |
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| Location | 3914 Hickory Ave, Baltimore, Maryland |
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| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1477365849
- Provider Enumeration Date: 01/23/2025
- Last Update Date: 05/12/2025
Medicare PECOS Information:
- PECOS PAC ID: 2961920467
- Enrollment ID: O20250519001765
Medical Identifiers
Medical identifiers for Ideal Wellness Llc such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1477365849 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 111NR0400X | Chiropractor - Rehabilitation | (* (Not Available)) | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| 261QP2000X | Clinic/center - Physical Therapy | (* (Not Available)) | Secondary |
| 261QP3300X | Clinic/center - Pain | (* (Not Available)) | Secondary |
| 332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Secondary |
| 332BC3200X | Durable Medical Equipment & Medical Supplies - Customized Equipment | (* (Not Available)) | Secondary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works.
Ideal Wellness Llc acts as a billing entity for following providers:
| Provider Name | Karen Donaldson |
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| Provider Type | Practitioner - Family Practice |
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| Provider Identifiers | NPI Number: 1578569786
PECOS PAC ID: 9032189022
Enrollment ID: I20040728000172 |
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| Provider Name | Michael Dorn |
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| Provider Type | Practitioner - Chiropractic |
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| Provider Identifiers | NPI Number: 1467460394
PECOS PAC ID: 2062690928
Enrollment ID: I20110623000124 |
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| Provider Name | Hellen Perpetual Nyamu |
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| Provider Type | Practitioner - Nurse Practitioner |
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| Provider Identifiers | NPI Number: 1295497121
PECOS PAC ID: 7911399225
Enrollment ID: I20220131001730 |
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| Provider Name | Jamesha Wise |
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| Provider Type | Practitioner - Nurse Practitioner |
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| Provider Identifiers | NPI Number: 1669053385
PECOS PAC ID: 3375947203
Enrollment ID: I20221018002582 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Ideal Wellness Llc is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Ideal Wellness Llc
3914 Hickory Ave,
Baltimore, MD 21211-1834
Ph: (410) 916-6888 | Ideal Wellness Llc
3914 Hickory Ave,
Baltimore, MD 21211-1834
Ph: (410) 916-6888 |
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