360 WELLNESS & NUTRITION, PA
NPI 1316603285
Family Medicine in Wilson, NC
About 360 Wellness & Nutrition, Pa NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
360 WELLNESS & NUTRITION, PA (NPI 1316603285) is a healthcare organization registered as a family medicine in Wilson, North Carolina and active in the NPI registry since November 2021. The organization holds a CLIA Waiver certificate valid through January 27, 2028 and lists Renu Kasula, Credentialing Specialist, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
360 Wellness & Nutrition, Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by December 31, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to 360 Wellness & Nutrition, PA, which bills Medicare for the services they deliver. Of these, 2 practice within 10 miles. They are listed nearest first.
Clinicians, nearest first (2)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 34D2250694
360 Wellness & Nutrition, PA · Wilson, NCFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is 360 Wellness & Nutrition, PA's NPI number?
The NPI number for 360 Wellness & Nutrition, PA is 1316603285. It was assigned to this organization in the NPPES registry on November 15, 2021.
Where is 360 Wellness & Nutrition, PA located?
360 Wellness & Nutrition, PA is located at 1704 Glendale Dr SW, Wilson, NC 27893. The listed phone number is (252) 237-1225.
What is 360 Wellness & Nutrition, PA's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is 360 Wellness & Nutrition, PA enrolled in Medicare?
Yes. 360 Wellness & Nutrition, PA is registered in the Medicare PECOS enrollment system.
When is 360 Wellness & Nutrition, PA's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (North Carolina, Clinic/Group Practice) is due for revalidation by December 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through 360 Wellness & Nutrition, PA?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to 360 Wellness & Nutrition, PA, in Family Practice and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does 360 Wellness & Nutrition, PA hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 34D2250694) is associated with this NPI, valid through January 27, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for 360 Wellness & Nutrition, PA was last updated on April 13, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# 360 Wellness & Nutrition, Pa · NPI 1316603285
Family Medicine organization in Wilson, North Carolina. Organization record, active in the CMS NPPES registry since November 15, 2021.
## Identity
- **NPI:** 1316603285 (Entity type: Organization)
- **Enumerated:** November 15, 2021
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Organization subpart:** No
- **Authorized official:** Renu Kasula, CREDENTIALING SPECIALIST
## Practice location
- **Address:** 1704 GLENDALE DR SW, Wilson, NC 27893-4678
- **Phone:** (252) 237-1225
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** December 31, 2026 (Non-DME Part B, North Carolina, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 2 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Family Practice (1), Nurse Practitioner (1); 2 practice within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** April 13, 2023
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1316603285) · Data from the CMS NPPES public registry.