NPIMap

Organization Active NPI

Neurosurgical Spine Institute LLC

  • Neurological Surgery Physician
  • Port Charlotte, FL
National Provider Identifier
1174166201
Registry record updated Mar 31, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
Legal business name
NEUROSURGICAL SPINE INSTITUTE LLC
Practice address
2400 Harbor Blvd Ste 15
Port Charlotte, FL 33952-5038
Phone
(941) 483-4000
Fax
(941) 480-1086
NPI assigned
Oct 22, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2026

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

Authorized official

Name
Dr. Marat Grigorov, DONPI 1063613628
Title
Owner
Phone
(941) 483-4000

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
Neurological Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207T00000X Primary

Addresses

Primary practice location

2400 Harbor Blvd Ste 15
Port Charlotte, FL 33952-5038

Mailing address

2400 Harbor Blvd Ste 15
Port Charlotte, FL 33952-5038
Phone (941) 483-4000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201005001407 FL Part B Supplier - Clinic/Group Practice 5294154688 Receives reassigned benefits from 1 practitioner
Practice locations: Port Charlotte, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

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": "1571702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1774915200000",
    "number": "1174166201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 HARBOR BLVD STE 15",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339525038",
            "telephone_number": "941-483-4000",
            "fax_number": "941-480-1086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 HARBOR BLVD STE 15",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339525038",
            "telephone_number": "941-483-4000",
            "fax_number": "941-480-1086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEUROSURGICAL SPINE INSTITUTE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-22",
        "last_updated": "2026-03-31",
        "certification_date": "2026-03-31",
        "status": "A",
        "authorized_official_last_name": "GRIGOROV",
        "authorized_official_first_name": "MARAT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "941-483-4000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Charlotte, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2026; 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.