Individual provider Active NPI

Allan Jay Birnbaum, D.O.

  • Internal Medicine Physician
  • Port Saint Lucie, FL
National Provider Identifier
1073549358
Registry record updated Mar 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
OS4258 Issued in FL
Practice address
1701 SE Hillmoor Dr
Suite #5
Port Saint Lucie, FL 34952-7552
Phone
(772) 485-7507
Fax
(772) 398-9505
NPI assigned
Jun 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X OS4258 FL Primary

Addresses

Primary practice location

1701 SE Hillmoor Dr
Suite #5
Port Saint Lucie, FL 34952-7552

Mailing address

1701 SE Hillmoor Dr
Suite #5
Port Saint Lucie, FL 34952-7552
Phone (772) 485-7507

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110405000634 FL Practitioner - Internal Medicine 3577532910 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Alexandra Berger, MD-P.a. Internal Medicine CurrentSince Feb 23, 2019 Accepting new patients

Locations

1701 SE Hillmoor Dr
Ste 5
Port St Lucie, FL 34952
Phone (772) 335-0060

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1151193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395273600000",
    "number": "1073549358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 SE HILLMOOR DR",
            "address_2": "SUITE #5",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349527552",
            "telephone_number": "772-485-7507",
            "fax_number": "772-398-9505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 SE HILLMOOR DR",
            "address_2": "SUITE #5",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349527552",
            "telephone_number": "772-485-7507",
            "fax_number": "772-398-9505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BIRNBAUM",
        "first_name": "ALLAN",
        "middle_name": "JAY",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-25",
        "last_updated": "2014-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "OS4258",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Saint Lucie, FL

Sources for this page

Verify at the official NPI Registry.