Jerzy Grzebieluch, MD, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

JERZY GRZEBIELUCH, MD, LLC

Practice address

4 2ND St SE
Fort Walton Beach, FL 32548-5502

Phone

(850) 864-2008

Fax

(850) 864-5008

NPI assigned

Sep 4, 2019

Organization subpart

No

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

Authorized official

Name

Jerzy Grzebieluch, MDNPI 1740397025

Title

Owner

Phone

(850) 864-2008

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

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

• Jerzy Grzebieluch, MD

  • Psychiatry Physician
  • Fort Walton Beach, FL
  • NPI 1740397025
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1567555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1567555200000",
    "number": "1447809298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 2ND ST SE",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325485502",
            "telephone_number": "850-864-2008",
            "fax_number": "850-864-5008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 2ND ST SE",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325485502",
            "telephone_number": "850-864-2008",
            "fax_number": "850-864-5008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERZY GRZEBIELUCH, MD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-04",
        "last_updated": "2019-09-04",
        "status": "A",
        "authorized_official_last_name": "GRZEBIELUCH",
        "authorized_official_first_name": "JERZY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-864-2008",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "visualpsychiatry.com",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "visualpsychiatry.com",
            "address_1": "4 2nd St SE",
            "city": "Fort Walton Beach",
            "state": "FL",
            "country_code": "US",
            "postal_code": "325485502",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jean Woo, DDS, P.a.
• Jennifer R Goette OD PA
• Jeremiah D. Patrick, D.M.D., P.a.
• Devon N Jernigan, PT, DPT
• Carl S Jerome, D.C.
• Philip Frank Alain Jessen, APRN
• Christian Jimenez, DMD
• Rachel Robinson Joern, PT
• John C Chaney MD FCCP PA
• John C Warburton MD PA

• Clinic/Center in Fort Walton Beach, FL
• Providers in Fort Walton Beach, FL by specialty
• Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2019; 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.