NPIMap

Organization Active NPI

Boca Medical Supply LLC

  • Durable Medical Equipment & Medical Supplies
  • Boca Raton, FL
National Provider Identifier
1063511129
Registry record updated Oct 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
2140 Issued in FL
Legal business name
BOCA MEDICAL SUPPLY LLC
Practice address
620 Glades Rd
Boca Raton, FL 33431-6414
Phone
(561) 368-7430
Fax
(561) 368-7401
NPI assigned
Sep 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2024

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

Authorized official

Name
Mr. Carl L English
Title
Managing Member
Phone
(561) 368-7430

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 2140 FL Primary
Oxygen Equipment & Supplies (DME) 332BX2000X 32 4369 FL
Prosthetic/Orthotic Supplier 335E00000X ORF113 FL

Addresses

Primary practice location

620 Glades Rd
Boca Raton, FL 33431-6414

Mailing address

620 Glades Rd
Boca Raton, FL 33431-6414
Phone (561) 368-7430

Other identifiers 2

IdentifierTypeStateIssuer
R9455OtherFLBLUE CROSS BLUE SHIELD
031820500MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930023422 FL DME Supplier - Medical Supply Company With Orthotic Personnel 6406062801 Practice locations: Boca Raton, FL

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Boca Medical Supply LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729209600000",
    "number": "1063511129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 GLADES RD",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334316414",
            "telephone_number": "561-368-7430",
            "fax_number": "561-368-7401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 GLADES RD",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334316414",
            "telephone_number": "561-368-7430",
            "fax_number": "561-368-7401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOCA MEDICAL SUPPLY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2024-10-18",
        "certification_date": "2024-10-18",
        "status": "A",
        "authorized_official_last_name": "ENGLISH",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "561-368-7430",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "FL",
            "license": "2140",
            "primary": true
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "FL",
            "license": "32 4369",
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "FL",
            "license": "ORF113",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "R9455",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "031820500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boca Raton, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2024; 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.