NPIMap

Organization Active NPI

Flagler Diagnostic & Sleeping Disorder, Inc, Inc

  • Sleep Disorder Diagnostic Clinic/Center
  • Bunnell, FL
National Provider Identifier
1013000652
Registry record updated Mar 22, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sleep Disorder Diagnostic Clinic/CenterTaxonomy code 261QS1200X
Legal business name
FLAGLER DIAGNOSTIC & SLEEPING DISORDER, INC, INC
Practice address
4721 E. Moody Blvd Suite 104
Bunnell, FL 32110
Phone
(386) 586-6229
Fax
(386) 263-2975
NPI assigned
Oct 2, 2006
Last updated
Mar 22, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2017

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

Authorized official

Name
Mrs. Kimberly L. Roches, CFE
Title
Facility Director
Phone
(386) 586-6229

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sleep Disorder Diagnostic Clinic/Center 261QS1200X Primary

Addresses

Primary practice location

4721 E. Moody Blvd Suite 104
Bunnell, FL 32110

Mailing address

4721 E. Moody Blvd Suite 104
Bunnell, FL 32110
Phone (386) 586-6229

Other identifiers 3

IdentifierTypeStateIssuer
018211800MedicaidFL
V3019OtherFLFL BLUE SHEILD
P00307040OtherFLRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050209000516 FL Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 2961453741 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bunnell, FL

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Flagler Diagnostic and Sleeping Disorder Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490140800000",
    "number": "1013000652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4721 E. MOODY BLVD SUITE 104",
            "city": "BUNNELL",
            "state": "FL",
            "postal_code": "32110",
            "telephone_number": "386-586-6229",
            "fax_number": "386-263-2975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4721 E. MOODY BLVD SUITE 104",
            "city": "BUNNELL",
            "state": "FL",
            "postal_code": "32110",
            "telephone_number": "386-586-6229",
            "fax_number": "386-263-2975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLAGLER DIAGNOSTIC & SLEEPING DISORDER, INC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2017-03-22",
        "status": "A",
        "authorized_official_last_name": "ROCHES",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "FACILITY DIRECTOR",
        "authorized_official_telephone_number": "386-586-6229",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CFE"
    },
    "taxonomies": [
        {
            "code": "261QS1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Sleep Disorder Diagnostic",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "018211800",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FL BLUE SHEILD",
            "identifier": "V3019",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00307040",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bunnell, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.