NPIMap

Organization Active NPI

FL Neuro Pain and Spine Center, .P.a.

  • Health Service Clinic/Center
  • Panama City, FL
National Provider Identifier
1194034397
Registry record updated Sep 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
License
CH 10072 Issued in FL
Legal business name
FL NEURO PAIN AND SPINE CENTER, .P.A.
Practice address
2614 Jenks Ave
Panama City, FL 32405-4311
Phone
(850) 215-3000
Fax
(850) 215-3150
NPI assigned
Oct 5, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2023

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

Authorized official

Name
Dr. Wesley JohnsonNPI 1902112170
Title
President
Phone
(850) 215-3000

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X
Health Service Clinic/Center 261QH0100X CH 10072 FL Primary

Addresses

Primary practice location

2614 Jenks Ave
Panama City, FL 32405-4311

Mailing address

2614 Jenks Ave
Panama City, FL 32405-4311
Phone (850) 215-3000

Other practice location 1

1008 Jenks Ave
Panama City, FL 32401-2437
Phone (850) 215-3000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120425000434 FL Part B Supplier - Clinic/Group Practice 1850553553 Receives reassigned benefits from 7 practitioners
Practice locations: Panama City, FL

National Provider Directory

National Provider Directory

Locations

8340 Front Beach Rd
Panama City Beach, FL 32407
Phone (850) 215-3000

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

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": "1286236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694131200000",
    "number": "1194034397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2614 JENKS AVE",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324054311",
            "telephone_number": "850-215-3000",
            "fax_number": "850-215-3150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2614 JENKS AVE",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324054311",
            "telephone_number": "850-215-3000",
            "fax_number": "850-215-3150"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1008 Jenks Ave",
            "address_purpose": "LOCATION",
            "city": "Panama City",
            "state": "FL",
            "postal_code": "324012437",
            "country_code": "US",
            "telephone_number": "850-215-3000",
            "fax_number": "850-215-3150",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FL NEURO PAIN AND SPINE CENTER, .P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-05",
        "last_updated": "2023-09-08",
        "certification_date": "2023-09-08",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "WESLEY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "850-215-3000",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "FL",
            "license": "CH 10072",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Panama City, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2023; 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.