FL Neuro Pain and Spine Center, .P.a.

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

FL NEURO PAIN AND SPINE CENTER, .P.A.

Practice address

2614 Jenks Ave
Panama City, FL 32405

Phone

(850) 215-3000

NPI assigned

Oct 16, 2019

Organization subpart

Yes

Parent organization

FL NEURO PAIN AND SPINE CENTER, .P.A.As reported in NPPES

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

Authorized official

Name

Wesley Johnson, DC

Title

Owner

Phone

(850) 215-3000

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Part of

FL Neuro Pain and Spine Center PA

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• FL Neuro Pain and Spine Center, .P.a.

  • Health Service Clinic/Center
  • Panama City, FL
  • NPI 1194034397
  NPPES parent name

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Melinda Ann Luther, ARNP-C

  • Nurse Practitioner
  • Panama City, FL
  • NPI 1942638341
  NPD
• John J O'Connell III, DO

  • Family Medicine Physician
  • Panama City, FL
  • NPI 1720028186
  NPD
• Bryan Pruess, ARNP

  • Family Nurse Practitioner
  • Panama City, FL
  • NPI 1679071799
  NPD
• Tisha Davis

  • Family Nurse Practitioner
  • Lynn Haven, FL
  • NPI 1093303588
  NPD (past)
• Cory Ann Imhof, D.C.

  • Chiropractor
  • Panama City, FL
  • NPI 1215259320
  NPD (past)
• Liza Danielle Ingram, DPT

  • Physical Therapist
  • Panama City Beach, FL
  • NPI 1295856730
  NPD (past)
• Nicole Marie Johnson

  • Nurse Practitioner
  • Panama City, FL
  • NPI 1710670013
  NPD (past)

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

{
    "created_epoch": "1571184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702339200000",
    "number": "1023650595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2614 JENKS AVE",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324054311",
            "telephone_number": "850-215-3000",
            "fax_number": "850-215-3150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2614 JENKS AVE",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "32405",
            "telephone_number": "850-215-3000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8340 Front Beach Rd",
            "address_purpose": "LOCATION",
            "city": "Panama City Beach",
            "state": "FL",
            "postal_code": "324074825",
            "country_code": "US",
            "telephone_number": "850-215-3000",
            "fax_number": "850-215-3150",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2614 Jenks Ave",
            "address_purpose": "LOCATION",
            "city": "Panama City",
            "state": "FL",
            "postal_code": "32405",
            "country_code": "US",
            "telephone_number": "850-215-3000",
            "fax_number": "850-215-3150",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FL NEURO PAIN AND SPINE CENTER, .P.A.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FL NEURO PAIN AND SPINE CENTER, .P.A.",
        "enumeration_date": "2019-10-16",
        "last_updated": "2023-12-12",
        "certification_date": "2023-12-12",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "WESLEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-215-3000",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "006J1",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "drwjohnson@flneuropain.com",
            "affiliation": "Y",
            "endpointDescription": "Secure Messaging",
            "affiliationName": "Fl Neuro Pain And Spine Center, .P.A.",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1008 Jenks Ave",
            "city": "Panama City",
            "state": "FL",
            "country_code": "US",
            "postal_code": "324012437",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Robin M. Fisher, A.R.N.P
• Cheryl G. Fitzgerald
• Stacy Danae Fitzgerald, LMT
• Kimberly Elaine Fitzpatrick, LMHC
• FL Medical Group
• FL Neuro Pain and Spine Center, .P.a.
• FL-I Medical Services LLC
• FL-I Medical Services LLC
• FL-I Medical Services, LLC
• Derek R Fleitz, D D S P A

• Health Service Clinic/Center in Panama City, FL
• Providers in Panama City, FL by specialty
• Health Service Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2023; 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.