Individual provider Active NPI

Debra B Balliram Manohalal, D.O.

  • Obstetrics & Gynecology Physician
  • Wellington, FL
National Provider Identifier
1053590489
Registry record updated Sep 25, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
OS10052 Issued in FL
Practice address
1447 Medical Park Blvd
Suite 300
Wellington, FL 33414-3164
Phone
(561) 790-5990
Fax
(561) 790-5952
NPI assigned
Nov 1, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X OS10052 FL Primary

Addresses

Primary practice location

1447 Medical Park Blvd
Suite 300
Wellington, FL 33414-3164

Mailing address

770 Northpoint Parkway
Suite 102
West Palm Beach, FL 33407
Phone (561) 275-7604

Other identifiers 1

IdentifierTypeStateIssuer
280386100MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080729000726 FL Practitioner - Obstetrics/Gynecology 1153495874 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Florida Woman Care LLCGroup PAC ID 5395807218, 607 clinicians

Practice addresses (Care Compare)

345 Jupiter Lakes Blvd
Suite 200
Jupiter, FL 33458-7100
Phone (561) 741-1957

Merit-based Incentive Payment System (MIPS)

Final score
88.76 of 100Reported as group
Quality
84.84
Promoting interoperability
100
Improvement activities
40
Cost
77.7

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles (2 of 4)

OrganizationSpecialtyStatusNew patients
Florida Woman Care, LLC Obstetrics & Gynecology CurrentSince May 17, 2018 Accepting new patients
Womencare PA Past Accepting new patients

Locations

2815 S Seacrest Blvd
Ste 112
Boynton Beach, FL 33435
Phone (561) 368-0233

345 Jupiter Lakes Blvd
Ste 200
Jupiter, FL 33458
Phone (561) 741-1957

2979 Pga Blvd
Ste 100
Palm Beach Gardens, FL 33410
Phone (561) 627-6801

1447 Medical Park Blvd
Ste 205
Wellington, FL 33414
Phone (561) 234-6599

1447 Medical Park Blvd
Ste 300
Wellington, FL 33414
Phone (561) 790-5990

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: debra.balliram-manohalal.1@13043.direct.athenahealth.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1193875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1506297600000",
    "number": "1053590489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "770 NORTHPOINT PARKWAY",
            "address_2": "SUITE 102",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "33407",
            "telephone_number": "561-275-7604",
            "fax_number": "561-802-5385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1447 MEDICAL PARK BLVD",
            "address_2": "SUITE 300",
            "city": "WELLINGTON",
            "state": "FL",
            "postal_code": "334143164",
            "telephone_number": "561-790-5990",
            "fax_number": "561-790-5952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALLIRAM MANOHALAL",
        "first_name": "DEBRA",
        "middle_name": "B",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-01",
        "last_updated": "2017-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "FL",
            "license": "OS10052",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "280386100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wellington, FL

Sources for this page

Verify at the official NPI Registry.