Wellspring – Pain Medicine Physician, NPI 1124100961
Pain Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Wellspring
747 E County Line Rd Ste J
Greenwood, IN 461431082
Phone: (317) 886-1529
Fax: (317) 866-1569
Type: Location
374 Northside Dr Ste A
Batesville, IN 470067052
Phone: (812) 717-4502
Fax: (812) 376-8625
Type: Location
455 S Landmark Ave
Bloomington, IN 474035004
Phone: (812) 269-7674
Fax: (812) 269-7718
Type: Location
3740 S 4th St
Terre Haute, IN 478025507
Phone: (812) 238-3030
Fax: (812) 238-3040
Type: Location
PO BOX 26395
BELFAST, ME 049152014
Phone: (812) 376-0700
Fax: (812) 376-8625
Type: Mailing
2400 NORTHPARK DR STE 20
COLUMBUS, IN 472034467
Phone: (812) 376-0700
Fax: (812) 376-8625
Type: Location
7951 SHOAL CREEK BLVD STE 300
AUSTIN, TX 787577582
Phone: (512) 584-8404
Fax: (812) 376-8625
Type: Mailing
2400, Columbus Circle, Camp Greene, Ashley Park, Charlotte, Mecklenburg County, North Carolina, 28208, United States
SUITE 20
COLUMBUS, IN 472034467
Phone: (812) 376-0700
Fax: (812) 376-8625
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2005-05-12
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2025-12-31 (161 days ago).
Enrollment records
1
Earliest due date
2025-12-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20050512000790 | O | Clinic/Group Practice | IN | 2025-12-31 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 46143)
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