NPIMap

Organization Active NPI

Path Medical, LLC

  • Clinic/Center
  • Port St Lucie, FL
National Provider Identifier
1003276635
Registry record updated Feb 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
PATH MEDICAL, LLC
Practice address
549 NW Lake Whitney PL Ste 101
Port St Lucie, FL 34986-1606
Phone
(772) 732-7874
Fax
(772) 300-9093
NPI assigned
Feb 24, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Neil Bonnardel, MD
Title
Director of Medical Services
Phone
(754) 218-2164

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

549 NW Lake Whitney PL Ste 101
Port St Lucie, FL 34986-1606

Mailing address

2304 W Oakland Park Blvd
Oakland Park, FL 33311-1422
Phone (754) 218-2164

Other identifiers 1

IdentifierTypeStateIssuer
HCC10776OtherFLSTATE LICENSE

Other names 1

  • Path Medical- Port St. Lucie Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Path Medical LLC24 organizations share this tax ID, including this one

Other organizations with this tax ID 23

Organizations that report the same tax identification number in the National Provider Directory.

View all 23

Locations

8138 W Broward Blvd
Plantation, FL 33324
Phone (954) 687-9339

549 NW Lake Whitney Pl
Ste 101
Port St Lucie, FL 34986
Phone (772) 879-2228

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1456272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612483200000",
    "number": "1003276635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2304 W OAKLAND PARK BLVD",
            "city": "OAKLAND PARK",
            "state": "FL",
            "postal_code": "333111422",
            "telephone_number": "754-218-2164",
            "fax_number": "954-473-0029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "549 NW LAKE WHITNEY PL STE 101",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349861606",
            "telephone_number": "772-732-7874",
            "fax_number": "772-300-9093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATH MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-24",
        "last_updated": "2021-02-05",
        "certification_date": "2021-02-01",
        "status": "A",
        "authorized_official_last_name": "BONNARDEL",
        "authorized_official_first_name": "NEIL",
        "authorized_official_title_or_position": "DIRECTOR OF MEDICAL SERVICES",
        "authorized_official_telephone_number": "754-218-2164",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "HCC10776",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Path Medical- Port St. Lucie",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Path Medical- Port St. Lucie",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port St Lucie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.