NPIMap

Organization Active NPI

Bruce H Paley PA

  • Dermatology Physician
  • St Augustine, FL
National Provider Identifier
1437568482
Registry record updated Aug 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
OS5622 Issued in FL
Legal business name
BRUCE H PALEY PA
Practice address
1851 Old Moultrie Rd
Suite B
St Augustine, FL 32084-4168
Phone
(904) 824-8088
Fax
(904) 826-4105
NPI assigned
Aug 4, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2014

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

Authorized official

Name
Dr. Bruce Henry Paley, DONPI 1619993375
Title
President of PA
Phone
(904) 824-8088

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X OS5622 FL Primary

Addresses

Primary practice location

1851 Old Moultrie Rd
Suite B
St Augustine, FL 32084-4168

Mailing address

1851 Old Moultrie Rd
Suite B
St Augustine, FL 32084-4168
Phone (904) 824-8088

Other identifiers 5

IdentifierTypeStateIssuer
371938300MedicaidFL
4394237OtherAETNA
80532OtherBLUE CROSS
070005035OtherRAILROAD MEDICARE
101894OtherAVMED

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140811001936 FL Part B Supplier - Clinic/Group Practice 3678790904 Receives reassigned benefits from 1 practitioner
Practice locations: Saint Augustine, FL

National Provider Directory

National Provider Directory

Locations

1851 Old Moultrie Rd
Ste B
St Augustine, FL 32084
Phone (904) 824-8088

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1407110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407110400000",
    "number": "1437568482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1851 OLD MOULTRIE RD",
            "address_2": "SUITE B",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320844168",
            "telephone_number": "904-824-8088",
            "fax_number": "904-826-4105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1851 OLD MOULTRIE RD",
            "address_2": "SUITE B",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320844168",
            "telephone_number": "904-824-8088",
            "fax_number": "904-826-4105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRUCE H PALEY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-04",
        "last_updated": "2014-08-04",
        "status": "A",
        "authorized_official_last_name": "PALEY",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "HENRY",
        "authorized_official_title_or_position": "PRESIDENT OF PA",
        "authorized_official_telephone_number": "904-824-8088",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "FL",
            "license": "OS5622",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "371938300",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4394237",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "80532",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "070005035",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVMED",
            "identifier": "101894",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Augustine, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2014; 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.