Organization Active NPI

Neuro-Stat

  • Neurology Physician
  • Clearwater, FL
National Provider Identifier
1104365550
Registry record updated Jan 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
NEURO-STAT
Practice address
501 S Lincoln Ave Ste 22
Clearwater, FL 33756-5964
Phone
(727) 357-7828
Fax
(727) 337-7646
NPI assigned
Feb 17, 2017
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Carl Tyler Shenkman, MDNPI 1083664874
Title
Ceo
Phone
(727) 330-6038

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Practitioners 7

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

Medicare participation

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

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20171121002049 FL Part B Supplier - Clinic/Group Practice 6305103698 Receives reassigned benefits from 2 practitioners
Practice locations: Clearwater, FL

National Provider Directory

National Provider Directory

Locations

200 2nd Ave S
St Petersburg, FL 33701
Phone (727) 465-8515

8142 Bellarus Way
Ste 104
Trinity, FL 34655
Phone (727) 202-1303

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084N0400X Primary

Addresses

NPPES NPI Registry

Primary practice location

501 S Lincoln Ave Ste 22
Clearwater, FL 33756-5964

Mailing address

501 S Lincoln Ave Ste 22
Clearwater, FL 33756-5964
Phone (727) 357-7828

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 8, 2024.

{
    "created_epoch": "1487289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704672000000",
    "number": "1104365550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 S LINCOLN AVE STE 22",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337565964",
            "telephone_number": "727-357-7828",
            "fax_number": "727-337-7646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 S LINCOLN AVE STE 22",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337565964",
            "telephone_number": "727-357-7828",
            "fax_number": "727-337-7646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEURO-STAT",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-17",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-08",
        "status": "A",
        "authorized_official_last_name": "SHENKMAN",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "TYLER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "727-330-6038",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clearwater, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2024; 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.