Active NPI
Wayne Mucci
- Family Medicine Physician
- West Palm Beach, FL
National Provider Identifier
1316947211
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- OS5584
- Practice address
- 2007 Palm Beach Lakes Blvd
West Palm Beach, FL 33409-6501 - Phone
- (561) 420-8555
- Fax
- (561) 420-8550
- NPI assigned
- Jul 21, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 25MB05189600 | NJ | |
| Family Medicine Physician | 207Q00000X | OS5584 | FL | Primary |
Addresses
Primary practice location
2007 Palm Beach Lakes Blvd
West Palm Beach, FL 33409-6501
Mailing address
2007 Palm Beach Lakes Blvd
West Palm Beach, FL 33409-6501
Phone (561) 420-8555
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4383941 | Other | NJ | AETNA PPO # |
| 0519349000 | Other | NJ | AMERIHEALTH # |
| 2692811 | Other | NJ | AETNA HMO # |
| 5009201 | Medicaid | NJ | |
| 223762143 | Other | NJ | TAX IDENTIFICATION # |
| 2K1863 | Other | NJ | HEALTHNET # |
| GLS035 | Other | NJ | OXFORD # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MB05189600 | NJ | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121904000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1487376000000",
"number": "1316947211",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2007 PALM BEACH LAKES BLVD",
"city": "WEST PALM BEACH",
"state": "FL",
"postal_code": "334096501",
"telephone_number": "561-420-8555",
"fax_number": "561-420-8550"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2007 PALM BEACH LAKES BLVD",
"city": "WEST PALM BEACH",
"state": "FL",
"postal_code": "334096501",
"telephone_number": "561-420-8555",
"fax_number": "561-420-8550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUCCI",
"first_name": "WAYNE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-07-21",
"last_updated": "2017-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NJ",
"license": "25MB05189600",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "FL",
"license": "OS5584",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA PPO #",
"identifier": "4383941",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIHEALTH #",
"identifier": "0519349000",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA HMO #",
"identifier": "2692811",
"state": "NJ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5009201",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX IDENTIFICATION #",
"identifier": "223762143",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHNET #",
"identifier": "2K1863",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD #",
"identifier": "GLS035",
"state": "NJ"
}
],
"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 Feb 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.