NPIMap

Individual provider Active NPI

Agnes Z Supala Berger, MD

  • Neurology Physician
  • Boca Raton, FL
National Provider Identifier
1245379932
Registry record updated Dec 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
ME157410 Issued in FL
Practice address
3848 Fau Blvd Ste 305
Boca Raton, FL 33431-6437
Phone
(305) 243-3100
Fax
(305) 243-8108
NPI assigned
Feb 6, 2007
Last updated
Dec 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X ME157410 FL Primary
Clinical Neurophysiology Physician 2084N0600X ME157410 FL

Addresses

Primary practice location

3848 Fau Blvd Ste 305
Boca Raton, FL 33431-6437

Mailing address

210 Brunswick Ave
Toronto, ONTARIO M5S 2M5
CA
Phone (416) 922-7902

Other identifiers 1

IdentifierTypeStateIssuer
238333OtherNYLICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221228001118 FL Practitioner - Neurology 9436258365 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University of MiamiGroup PAC ID 3274795109, 2,346 clinicians

Practice addresses (Care Compare)

3848 Fau Blvd
S305
Boca Raton, FL 33431-6437
Phone (305) 243-3564

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.93 of 100Reported as group
Quality
78.79
Promoting interoperability
100
Improvement activities
40
Cost
71.44

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME157410FLMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Miami Current Accepting new patients
University of Miami CurrentSince Nov 1, 2022 Accepting new patients
University of Miami Neurology CurrentSince Nov 1, 2022 Accepting new patients
University of Miami Past Accepting new patients
University Neurology, Inc. Neurology Past Accepting new patients

Locations

3848 Fau Blvd
#S305
Boca Raton, FL 33431

3848 Fau Blvd
Ste 305
Boca Raton, FL 33431
Phone (561) 455-3627

4800 NE 20th Ter
Ste 201
Ft Lauderdale, FL 33308
Phone (305) 892-4000

1150 NW 14th St
Ste 609
Miami, FL 33136
Phone (305) 243-7400

1611 NW 12th Ave
Miami, FL 33136
Phone (305) 585-6226

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: asupalaberger115510@direct.med.miami.edu

Organizations & group practices 5

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 2

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": "1170720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671580800000",
    "number": "1245379932",
    "addresses": [
        {
            "country_code": "CA",
            "country_name": "Canada",
            "address_purpose": "MAILING",
            "address_type": "FGN",
            "address_1": "210 BRUNSWICK AVE",
            "city": "TORONTO",
            "state": "ONTARIO",
            "postal_code": "M5S 2M5",
            "telephone_number": "416-922-7902",
            "fax_number": "416-922-7902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3848 FAU BLVD STE 305",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334316437",
            "telephone_number": "305-243-3100",
            "fax_number": "305-243-8108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUPALA BERGER",
        "first_name": "AGNES",
        "middle_name": "Z",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-06",
        "last_updated": "2022-12-21",
        "certification_date": "2022-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "FL",
            "license": "ME157410",
            "primary": true
        },
        {
            "code": "2084N0600X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": "FL",
            "license": "ME157410",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "238333",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boca Raton, FL

Sources for this page

Verify at the official NPI Registry.