NPIMap

Organization Active NPI

Jay S. Herbst M.D., P.a.

  • Procedural Dermatology Physician
  • Port Charlotte, FL
National Provider Identifier
1033488424
Registry record updated Dec 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Procedural Dermatology PhysicianTaxonomy code 207NS0135X
License
ME 46734 Issued in FL
Legal business name
JAY S. HERBST M.D., P.A.
Practice address
2866 Tamiami TRL
Suite a
Port Charlotte, FL 33952-5126
Phone
(941) 764-1055
Fax
(941) 764-7984
NPI assigned
Dec 14, 2011
Last updated
Dec 14, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2011

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

Authorized official

Name
Dr. Jay Steven Herbst, M.D.NPI 1710047097
Title
Medical Director
Phone
(941) 764-1055

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Procedural Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207NS0135X ME 46734 FL Primary

Addresses

Primary practice location

2866 Tamiami TRL
Suite a
Port Charlotte, FL 33952-5126

Mailing address

2866 Tamiami TRL
Suite a
Port Charlotte, FL 33952-5126
Phone (941) 764-1055

Other names 1

  • South Florida Skin Center Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120105000346 FL Part B Supplier - Clinic/Group Practice 2961678487 Receives reassigned benefits from 4 practitioners
Practice locations: Port Charlotte, FL

National Provider Directory

National Provider Directory

Locations

2866 Tamiami Trl
Pt Charlotte, FL 33952
Phone (941) 629-3535

2866 Tamiami Trl
Ste A
Pt Charlotte, FL 33952
Phone (941) 764-1055

Practitioners & affiliated clinicians

Practitioners 6

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": "1323820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323820800000",
    "number": "1033488424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2866 TAMIAMI TRL",
            "address_2": "SUITE A",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339525126",
            "telephone_number": "941-764-1055",
            "fax_number": "941-764-7984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2866 TAMIAMI TRL",
            "address_2": "SUITE A",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339525126",
            "telephone_number": "941-764-1055",
            "fax_number": "941-764-7984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAY S. HERBST M.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-14",
        "last_updated": "2011-12-14",
        "status": "A",
        "authorized_official_last_name": "HERBST",
        "authorized_official_first_name": "JAY",
        "authorized_official_middle_name": "STEVEN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "941-764-1055",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "FL",
            "license": "ME 46734",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Florida Skin Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Port Charlotte, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2011; 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.