Organization Active NPI

Regina B Portnova MD Inc

  • Internal Medicine Physician
  • Lauderdale Lakes, FL
National Provider Identifier
1336165349
Registry record updated Oct 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME 91789 Issued in FL
Legal business name
REGINA B PORTNOVA MD INC
Practice address
2951 NW 49 Ave
Suite 201
Lauderdale Lakes, FL 33313
Phone
(954) 486-5700
Fax
(954) 484-2574
NPI assigned
Jul 14, 2006
Last updated
Oct 26, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2015

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

Authorized official

Name
Mr. Stanislav Portnov
Title
Office Director
Phone
(954) 486-5700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME 91789 FL Primary

Addresses

Primary practice location

2951 NW 49 Ave
Suite 201
Lauderdale Lakes, FL 33313

Mailing address

2951 NW 49 Ave
Suite 201
Lauderdale Lakes, FL 33313
Phone (954) 486-5700

Other identifiers 2

IdentifierTypeStateIssuer
004877800MedicaidFL
271339000MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051031000253 FL Part B Supplier - Clinic/Group Practice 3274550165 Receives reassigned benefits from 2 practitioners
Practice locations: Tamarac, FL; Sunrise, FL; Lauderhill, FL; Lauderdale Lakes, FL; Coral Springs, FL

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/12248/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 3

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": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445817600000",
    "number": "1336165349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2951 NW 49 AVE",
            "address_2": "SUITE 201",
            "city": "LAUDERDALE LAKES",
            "state": "FL",
            "postal_code": "33313",
            "telephone_number": "954-486-5700",
            "fax_number": "954-484-2574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2951 NW 49 AVE",
            "address_2": "SUITE 201",
            "city": "LAUDERDALE LAKES",
            "state": "FL",
            "postal_code": "33313",
            "telephone_number": "954-486-5700",
            "fax_number": "954-484-2574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGINA B PORTNOVA MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2015-10-26",
        "status": "A",
        "authorized_official_last_name": "PORTNOV",
        "authorized_official_first_name": "STANISLAV",
        "authorized_official_title_or_position": "OFFICE DIRECTOR",
        "authorized_official_telephone_number": "954-486-5700",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME 91789",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004877800",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "271339000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lauderdale Lakes, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.