Organization Active NPI

Columbia Primary Care LLC

  • Internal Medicine Physician
  • West Palm Beach, FL
National Provider Identifier
1265567994
Registry record updated Sep 27, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
COLUMBIA PRIMARY CARE LLC
Practice address
4631 N Congress Ave
Suite 202
West Palm Beach, FL 33407-3209
Phone
(561) 881-2640
Fax
(561) 863-2304
NPI assigned
Feb 22, 2007
Last updated
Sep 27, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2007

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

Authorized official

Name
Gary Duncan
Title
VP
Phone
(561) 881-2640

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X Primary

Addresses

Primary practice location

4631 N Congress Ave
Suite 202
West Palm Beach, FL 33407-3209

Mailing address

4631 N Congress Ave
Suite 202
West Palm Beach, FL 33407-3209
Phone (561) 881-2640

Other identifiers 1

IdentifierTypeStateIssuer
DF4508OtherFLRAILROAD MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060419000140 FL Part B Supplier - Clinic/Group Practice 7810906823 Receives reassigned benefits from 22 practitioners
1 other NPI on this enrollment
Practice locations: Margate, FL; Miami, FL; Palm Beach Gardens, FL; Plantation, FL; Tamarac, FL; West Palm Beach, FL; Atlantis, FL; Aventura, FL…

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D1050247Columbia Primary Care LLC Dba4631 N Congress Ave Ste 102, West Palm Beach, FL 33407Certificate of waiverJan 29, 2028

National Provider Directory

National Provider Directory

Locations

1001 Wynmoor Cir
Ste 102
Coconut Creek, FL 33066

1310 Avenue of the Stars
Coconut Creek, FL 33066
Phone (954) 571-6997

9800 W Sample Rd
Ste B
Coral Springs, FL 33065
Phone (954) 341-3739

2825 N State Road 7
Ste 304
Margate, FL 33063
Phone (954) 977-4101

2960 N State Road 7
Ste 204
Margate, FL 33063
Phone (954) 972-7224

2964 N State Road 7
Margate, FL 33063

5901 Colonial Dr
Margate, FL 33063
Phone (954) 755-2121

5901 Colonial Dr
Ste 110
Margate, FL 33063
Phone (954) 977-8442

21097 NE 27th Ct
Ste 100
Miami, FL 33180
Phone (305) 792-0012

8251 W Broward Blvd
Plantation, FL 33324
Phone (954) 473-5600

8251 W Broward Blvd
Ste 304
Plantation, FL 33324
Phone (954) 731-1101

4201 N University Dr
Sunrise, FL 33351
Phone (954) 977-4101

4631 N Congress Ave
Ste 200
West Palm Beach, FL 33407
Phone (561) 845-0175

4631 N Congress Ave
Ste 202
West Palm Beach, FL 33407
Phone (561) 530-1725

4700 N Congress Ave
Ste 201
West Palm Beach, FL 33407
Phone (561) 881-2640

Networks

  • HealthSun Health Plans Network

Practitioners & affiliated clinicians

Practitioners 34

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.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190851200000",
    "number": "1265567994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4631 N CONGRESS AVE",
            "address_2": "SUITE 202",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334073209",
            "telephone_number": "561-881-2640",
            "fax_number": "561-863-2304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4631 N CONGRESS AVE",
            "address_2": "SUITE 202",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334073209",
            "telephone_number": "561-881-2640",
            "fax_number": "561-863-2304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUMBIA PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-22",
        "last_updated": "2007-09-27",
        "status": "A",
        "authorized_official_last_name": "DUNCAN",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "561-881-2640"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DF4508",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Palm Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2007; 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.