Individual provider Active NPI

Richard B Allen, MD

  • Otolaryngic Allergy Physician
  • Fort Pierce, FL
National Provider Identifier
1124136155
Registry record updated Jul 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngic Allergy PhysicianTaxonomy code 207YX0602X
License
ME33479 Issued in FL
Practice address
4632 S 25TH St
Fort Pierce, FL 34981-5057
Phone
(772) 464-9595
Fax
(772) 464-9582
NPI assigned
Aug 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngic Allergy Physician 207YX0602X ME33479 FL Primary

Addresses

Primary practice location

4632 S 25TH St
Fort Pierce, FL 34981-5057

Mailing address

4632 S 25TH St
Fort Pierce, FL 34981-5057
Phone (772) 464-9595

Other identifiers 1

IdentifierTypeStateIssuer
255052100MedicaidFL

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
I20100910000190 FL Practitioner - Otolaryngology 5294791349

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME33479FLMDOtolaryngic Allergy Physician

Practice roles

OrganizationSpecialtyStatusNew patients
ENT and Allergy Associates of Florida, LLC CurrentSince Jun 1, 2023 Accepting new patients

Locations

4632 S 25th St
Fort Pierce, FL 34981
Phone (772) 464-9595

1801 SE Hillmoor Dr
Ste B-105
Port St Lucie, FL 34952
Phone (561) 398-9911

Interoperability endpoints

  • Direct secure messaging: richardallen@face.ssdirect.aprima.com

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": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278633600000",
    "number": "1124136155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4632 S 25TH ST",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349815057",
            "telephone_number": "772-464-9595",
            "fax_number": "772-464-9582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4632 S 25TH ST",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349815057",
            "telephone_number": "772-464-9595",
            "fax_number": "772-464-9582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALLEN",
        "first_name": "RICHARD",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-29",
        "last_updated": "2010-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YX0602X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngic Allergy",
            "state": "FL",
            "license": "ME33479",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "255052100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Pierce, FL

Sources for this page

Verify at the official NPI Registry.