Intermed of Boca Raton, Inc

Primary specialty

Allergy & Immunology PhysicianTaxonomy code 207K00000X

Legal business name

INTERMED OF BOCA RATON, INC

Practice address

950 Glades Rd Ste 4D
Boca Raton, FL 33431-6401

Phone

(561) 391-8086

Fax

(954) 354-8151

NPI assigned

Jan 7, 2016

Organization subpart

No

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

Authorized official

Name

Chantal Bray

Title

Ceo

Phone

(954) 254-7968

Specialties & licenses 3

Addresses

Other identifiers 1

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1452124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626048000000",
    "number": "1407212327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4855 W HILLSBORO BLVD",
            "address_2": "SUITE B2",
            "city": "COCONUT CREEK",
            "state": "FL",
            "postal_code": "330734356",
            "telephone_number": "954-418-1683",
            "fax_number": "954-354-8151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 GLADES RD STE 4D",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334316401",
            "telephone_number": "561-391-8086",
            "fax_number": "954-354-8151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERMED OF BOCA RATON, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-07",
        "last_updated": "2021-07-12",
        "certification_date": "2021-07-12",
        "status": "A",
        "authorized_official_last_name": "BRAY",
        "authorized_official_first_name": "CHANTAL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "954-254-7968"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Allergy & Immunology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "74563",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "BOCARATOM",
            "affiliation": "N",
            "address_1": "950 Glades Rd # 4D",
            "city": "Boca Raton",
            "state": "FL",
            "country_code": "US",
            "postal_code": "334316401",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.