Regenerative Medical Group Florida

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

REGENERATIVE MEDICAL GROUP FLORIDA

Practice address

1400 SE Goldtree Dr Ste 105
Port St Lucie, FL 34952-7582

Phone

(772) 207-7534

Fax

(772) 777-2837

NPI assigned

Dec 22, 2017

Organization subpart

No

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

Authorized official

Name

Shane Donald Whiteley, CHIROPRACTORNPI 1003849449

Title

Owner

Phone

(772) 207-7534

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 2

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

• Steven Earnest Rahman, MD

  • Pediatrics Physician
  • Wellington, FL
  • NPI 1710083811
  Medicare reassignment NPD
• Shane Donald Whiteley, DC

  • Chiropractor
  • Port St Lucie, FL
  • NPI 1003849449
  NPD Authorized official

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

{
    "created_epoch": "1513900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1513900800000",
    "number": "1144736471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 SE GOLDTREE DR STE 105",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349527582",
            "telephone_number": "772-207-7534",
            "fax_number": "772-777-2837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 SE GOLDTREE DR STE 105",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349527582",
            "telephone_number": "772-207-7534",
            "fax_number": "772-777-2837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGENERATIVE MEDICAL GROUP FLORIDA",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-22",
        "last_updated": "2017-12-22",
        "status": "A",
        "authorized_official_last_name": "WHITELEY",
        "authorized_official_first_name": "SHANE",
        "authorized_official_middle_name": "DONALD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "772-207-7534",
        "authorized_official_credential": "CHIROPRACTOR"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Abby Regan
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• Mary Jill Reichert
• Hyacinth Reid
• Jahlis Amaia Reid
• Michelle Reid, OTR/L

• Family Medicine Physician in Port St Lucie, FL
• Providers in Port St Lucie, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2017; 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.