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Glomar Medical Inc.

Organization Active NPI Gerontology Nurse Practitioner · Palm Bay, FL

NPI 1053913095 · NPPES record last updated Dec 3, 2020

Key facts

NPI
1053913095
Entity type
Organization (NPI type 2)
Primary specialty
Gerontology Nurse Practitioner 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
Organization subpart
No

Authorized official

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

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

Practitioners 14

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in FL, AR

Medicare enrollment records

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

Locations

4313 S Pleasant Crossing Blvd
#B
Rogers, AR 72758
Phone (479) 341-4003

4313 S Pleasant Crossing Blvd
Rogers, AR 72758
Phone (479) 341-4003

1279 Houston St
Melbourne, FL 32935
Phone (321) 622-6730

Interoperability endpoints

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

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner
Group: 193400000X SINGLE SPECIALTY GROUP		 363LG0600X Yes

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

  • Glomar Medical LLC Former legal business name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 3, 2020.

{
    "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

All providers in Palm Bay, FL · Gerontology Nurse Practitioner in Florida

Sources for this page

Verify at the official NPI Registry.