NPIMap

Organization Active NPI

Independence Ear, Nose & Throat, LLC

  • Otolaryngology Physician
  • Stuart, FL
National Provider Identifier
1063913713
Registry record updated Apr 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
INDEPENDENCE EAR, NOSE & THROAT, LLC
Practice address
1400 NW Federal Hwy
Stuart, FL 34994-1020
Phone
(772) 285-5334
NPI assigned
Feb 27, 2018
Last updated
Apr 14, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2022

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

Authorized official

Name
Mrs. Kaitlyn C Lustgarten
Title
Manager
Phone
(772) 888-1880

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X NU Primary

Addresses

Primary practice location

1400 NW Federal Hwy
Stuart, FL 34994-1020

Mailing address

1400 NW Federal Hwy
Stuart, FL 34994-1020
Phone (772) 888-1880

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180822000737 FL Part B Supplier - Clinic/Group Practice 1254680481 Receives reassigned benefits from 12 practitioners
Practice locations: Port Saint Lucie, FL; Stuart, FL

National Provider Directory

National Provider Directory

Locations

1400 NW US 1
Stuart, FL 34994
Phone (772) 888-1880

931 SE Ocean Blvd
Ste A
Stuart, FL 34994
Phone (772) 283-3820

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BEFDCD

Practitioners & affiliated clinicians

Practitioners 12

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": "1519689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649894400000",
    "number": "1063913713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 NW FEDERAL HWY",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349941020",
            "telephone_number": "772-888-1880",
            "fax_number": "855-618-2315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 NW FEDERAL HWY",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349941020",
            "telephone_number": "772-285-5334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENCE EAR, NOSE & THROAT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-27",
        "last_updated": "2022-04-14",
        "certification_date": "2022-04-08",
        "status": "A",
        "authorized_official_last_name": "LUSTGARTEN",
        "authorized_official_first_name": "KAITLYN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "772-888-1880",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stuart, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2022; 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.