NPIMap

Organization Active NPI

Lake Worth Medical PA

  • Internal Medicine Physician
  • Greenacres, FL
National Provider Identifier
1205086063
Registry record updated Feb 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
LAKE WORTH MEDICAL PA
Practice address
2938 Jog Rd
Greenacres, FL 33467-2002
Phone
(561) 432-3455
Fax
(561) 432-8755
NPI assigned
Sep 29, 2008
Last updated
Feb 6, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2009

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

Authorized official

Name
Dr. Mario BaezNPI 1255303509
Title
Part Owner
Phone
(561) 432-3455

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
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

2938 Jog Rd
Greenacres, FL 33467-2002

Mailing address

2938 Jog Rd
Greenacres, FL 33467-2002
Phone (561) 432-3455

National Provider Directory

National Provider Directory

Locations

2938 S Jog Rd
Greenacres, FL 33467
Phone (561) 432-3455

Practitioners & affiliated clinicians

Practitioners 5

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": "1222646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1233878400000",
    "number": "1205086063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2938 JOG RD",
            "city": "GREENACRES",
            "state": "FL",
            "postal_code": "334672002",
            "telephone_number": "561-432-3455",
            "fax_number": "561-432-8755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2938 JOG RD",
            "city": "GREENACRES",
            "state": "FL",
            "postal_code": "334672002",
            "telephone_number": "561-432-3455",
            "fax_number": "561-432-8755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE WORTH MEDICAL PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-29",
        "last_updated": "2009-02-06",
        "status": "A",
        "authorized_official_last_name": "BAEZ",
        "authorized_official_first_name": "MARIO",
        "authorized_official_title_or_position": "PART OWNER",
        "authorized_official_telephone_number": "561-432-3455",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenacres, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.