Active NPI
Brain and Spine Instate for Children
- Preferred Provider Organization
- Orlando, FL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Preferred Provider Organization
- License
- ME 102412
- Legal business name
- BRAIN AND SPINE INSTATE FOR CHILDREN
- Practice address
- 2813 S Hiawassee Rd
Suite 201
Orlando, FL 32835-6300 - Phone
- (407) 378-5100
- NPI assigned
- Feb 19, 2013
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Keyne K Johnson, M.D.
- Title
- Medical Director
- Phone
- (407) 378-5100
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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Preferred Provider Organization | 305R00000X | ME 102412 | FL | Primary |
Addresses
Primary practice location
2813 S Hiawassee Rd
Suite 201
Orlando, FL 32835-6300
Mailing address
2813 S Hiawassee Rd
Suite 201
Orlando, FL 32835-6300
Phone (407) 378-5100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000384900 | Medicaid | FL |
Other names 1
- Basic
National Provider Directory
National Provider Directory- Tax ID family
- Basic
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Neurological Surgery Physician
- Orlando, FL
- NPI 1821339144
Locations
2813 S Hiawassee Rd
Ste 201
Orlando, FL 32835
Phone (407) 378-5100
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Neurological Surgery Physician
- Winter Park, FL
- NPI 1053577015
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1361232000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1361232000000",
"number": "1104166735",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2813 S HIAWASSEE RD",
"address_2": "SUITE 201",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328356300",
"telephone_number": "407-378-5100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2813 S HIAWASSEE RD",
"address_2": "SUITE 201",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328356300",
"telephone_number": "407-378-5100"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BRAIN AND SPINE INSTATE FOR CHILDREN",
"organizational_subpart": "NO",
"enumeration_date": "2013-02-19",
"last_updated": "2013-02-19",
"status": "A",
"authorized_official_last_name": "JOHNSON",
"authorized_official_first_name": "KEYNE",
"authorized_official_middle_name": "K",
"authorized_official_title_or_position": "MEDICAL DIRECTOR",
"authorized_official_telephone_number": "407-378-5100",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "305R00000X",
"taxonomy_group": "",
"desc": "Preferred Provider Organization",
"state": "FL",
"license": "ME 102412",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000384900",
"state": "FL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Basic",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Orlando, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.