Look up the most recent NPI and PECOS records

Carl Watt Wherry

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

300 Medical Plz, Suite B200, Los Angeles, CA 90095-0001

PECOS Enrollment

This provider is enrolled in PECOS as CARL WHERRY.

Based on the most recent information from CMS, provider Carl Watt Wherry is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 11 days ago.

Profile Details

Provider ID
1841207560
Provider Type
Individual
Full Name
Wherry, Carl Watt
Credential
NP

Gender
Male
Sole Proprietor
No
Enumeration Date
8/2/2006
Last Updated
3/18/2011

Contact Information

Practice Location

300 Medical Plz, Suite B200, Los Angeles, CA 90095-0001

(310) 794-1195

Unlisted Fax

Mailing Location

5767 W Century Blvd, Suite 400, Los Angeles, CA 90045-5631

(310) 794-1195

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363LA2100X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License NP14878 California
Code 363L00000X	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 14878 California
Code 363LA2100X	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License RN578343 California

Provider Identifiers

ID	Description	Issuer
ID RN578343	Description Medicaid	Issuer Unlisted California
ID NP14878	Description Medicaid	Issuer Unlisted California

Carl Watt Wherry

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

Miller, Pamela S

Gewarges, Renee Mary

Peralta, Joyce V

O'Loughlin, Daniel Cody

Lee, Calvin Ping-Jin

Rhodes, Sarah

Chertboonmuang, Parntip

Bohan, Brittni

Houser, Linda

Ong, Joe Andrews