NPIMap

Organization Active NPI

Glomar Medical Inc.

  • Gerontology Nurse Practitioner
  • Palm Bay, FL
National Provider Identifier
1053913095
Registry record updated Dec 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
Legal business name
GLOMAR MEDICAL INC.
Practice address
341 Allison Dr
Palm Bay, FL 32908-6405
Phone
(321) 543-9830
NPI assigned
Nov 13, 2020
Last updated
Dec 3, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2020

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

Authorized official

Name
Neil J Frey, APRNNPI 1265093074
Title
Chief Executive Officer
Phone
(321) 543-9830

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
Gerontology Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LG0600X Primary

Addresses

Primary practice location

341 Allison Dr
Palm Bay, FL 32908-6405

Mailing address

341 Allison Dr
Palm Bay, FL 32908-6405
Phone (321) 543-9830

Other names 1

  • Glomar Medical LLC Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, AR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20210122000268 FL Part B Supplier - Clinic/Group Practice 0244644862 Receives reassigned benefits from 14 practitioners
Practice locations: Melbourne, FL; Palm Bay, FL
O20231130000418 AR Part B Supplier - Clinic/Group Practice 0244644862 Receives reassigned benefits from 1 practitioner
Practice locations: Rogers, AR

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/23115/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1605225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606953600000",
    "number": "1053913095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "341 ALLISON DR",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329086405",
            "telephone_number": "321-543-9830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "341 ALLISON DR",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329086405",
            "telephone_number": "321-543-9830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLOMAR MEDICAL INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-13",
        "last_updated": "2020-12-03",
        "certification_date": "2020-12-03",
        "status": "A",
        "authorized_official_last_name": "FREY",
        "authorized_official_first_name": "NEIL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "321-543-9830",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Glomar Medical LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Palm Bay, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2020; 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.