NPIMap

Organization Active NPI

Soma Medical Center PA #5

  • Internal Medicine Physician
  • Lake Worth, FL
National Provider Identifier
1063754588
Registry record updated Sep 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
SOMA MEDICAL CENTER PA #5
Practice address
330 S Dixie Hwy
Lake Worth, FL 33460-4400
Phone
(561) 227-3993
Fax
(561) 855-4308
NPI assigned
Mar 22, 2013
Last updated
Sep 26, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2023

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

Authorized official

Name
Dr. Rafael O Nunez, MDNPI 1043208895
Title
Medical Director
Phone
(561) 964-4577

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary
Primary Care Clinic/Center 261QP2300X

Addresses

Primary practice location

330 S Dixie Hwy
Lake Worth, FL 33460-4400

Mailing address

330 S Dixie Hwy
Lake Worth, FL 33460-4400
Phone (561) 227-3993

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230426002849 FL Part B Supplier - Clinic/Group Practice 4688039605 Receives reassigned benefits from 2 practitioners
Practice locations: Lake Worth, FL

National Provider Directory

National Provider Directory

Locations

3319 S State Road 7
Ste 109111
Wellington, FL 33449

Practitioners & affiliated clinicians

Practitioners 3

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": "1363910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695686400000",
    "number": "1063754588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 S DIXIE HWY",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "334604400",
            "telephone_number": "561-227-3993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 S DIXIE HWY",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "334604400",
            "telephone_number": "561-227-3993",
            "fax_number": "561-855-4308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOMA MEDICAL CENTER PA #5",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-22",
        "last_updated": "2023-09-26",
        "certification_date": "2023-09-11",
        "status": "A",
        "authorized_official_last_name": "NUNEZ",
        "authorized_official_first_name": "RAFAEL",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "561-964-4577",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Worth, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2023; 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.