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
Last updated
Jan 8, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2024

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

Authorized official

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.

Specialties & licenses 1

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

Addresses

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

Medicare participation

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

Enrollment records 1

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

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

Practitioners & affiliated clinicians

Practitioners 7

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": "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.