NPIMap

Organization Active NPI

Sanctuary Medical Aesthetic Center of Boca Raton LLC

  • Dermatology Physician
  • Boca Raton, FL
National Provider Identifier
1104282714
Registry record updated May 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
SANCTUARY MEDICAL AESTHETIC CENTER OF BOCA RATON LLC
Practice address
4800 N Federal Hwy
Suite C100
Boca Raton, FL 33431-5188
Phone
(561) 886-0970
NPI assigned
Jan 12, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2016

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

Authorized official

Name
Jeff Davis
Title
Ceo
Phone
(561) 430-6644

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

4800 N Federal Hwy
Suite C100
Boca Raton, FL 33431-5188

Mailing address

4800 N Federal Hwy
Suite C100
Boca Raton, FL 33431-5188
Phone (561) 886-0970

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160719002523 FL Part B Supplier - Clinic/Group Practice 4284927872 Receives reassigned benefits from 4 practitioners
Practice locations: Boca Raton, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1452556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463702400000",
    "number": "1104282714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 N FEDERAL HWY",
            "address_2": "SUITE C100",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334315188",
            "telephone_number": "561-886-0970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 N FEDERAL HWY",
            "address_2": "SUITE C100",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334315188",
            "telephone_number": "561-886-0970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANCTUARY MEDICAL AESTHETIC CENTER OF BOCA RATON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-12",
        "last_updated": "2016-05-20",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "561-430-6644"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 May 20, 2016; 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.