Individual provider Active NPI

Jack S Pasula, DC

  • Chiropractor
  • Deerfield Beach, FL
National Provider Identifier
1235176314
Registry record updated Nov 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH9028 Issued in FL
Practice address
1883 W Hillsboro Blvd
Deerfield Beach, FL 33442-1401
Phone
(561) 483-3900
Fax
(561) 483-5554
NPI assigned
May 31, 2006
Last updated
Nov 2, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH9028 FL Primary

Addresses

Primary practice location

1883 W Hillsboro Blvd
Deerfield Beach, FL 33442-1401

Mailing address

1883 W Hillsboro Blvd
Deerfield Beach, FL 33442-1401
Phone (561) 483-3900

Other practice location 1

20925 Lyons Rd
Boca Raton, FL 33428-1423
Phone (561) 483-3900

Other identifiers 2

IdentifierTypeStateIssuer
NELF9OtherFLBCBS FL
60758OtherGABLUE CROSS BLUE SHIELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060821000026 FL Practitioner - Chiropractic 5597768119 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Life Chiropractic College - West, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1883 W Hillsboro Blvd
Deerfield Beach, FL 33442-1401
Phone (561) 483-3900

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CH9028FLMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Jack Pasula DC PA CurrentSince Sep 12, 2008 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Salvatore Larusso D C P a II Chiropractor PastSince Feb 1, 2002 Accepting new patients

Locations

20925 Lyons Rd
Boca Raton, FL 33428
Phone (561) 482-9640

1883 W Hillsboro Blvd
Deerfield Beach, FL 33442
Phone (561) 483-3900

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572652800000",
    "number": "1235176314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1883 W HILLSBORO BLVD",
            "city": "DEERFIELD BEACH",
            "state": "FL",
            "postal_code": "334421401",
            "telephone_number": "561-483-3900",
            "fax_number": "561-483-5554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1883 W HILLSBORO BLVD",
            "city": "DEERFIELD BEACH",
            "state": "FL",
            "postal_code": "334421401",
            "telephone_number": "561-483-3900",
            "fax_number": "561-483-5554"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20925 Lyons Rd",
            "address_purpose": "LOCATION",
            "city": "Boca Raton",
            "state": "FL",
            "postal_code": "334281423",
            "country_code": "US",
            "telephone_number": "561-483-3900",
            "fax_number": "561-483-5554",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PASULA",
        "first_name": "JACK",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-31",
        "last_updated": "2019-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH9028",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS FL",
            "identifier": "NELF9",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "60758",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Deerfield Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.