Organization Active NPI

Bower Urology LLC

  • Urology Physician
  • Port St Lucie, FL
National Provider Identifier
1467130294
Registry record updated May 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
BOWER UROLOGY LLC
Practice address
1941 SE Port St Lucie Blvd
Port St Lucie, FL 34952-5535
Phone
(772) 340-6777
Fax
(772) 236-3002
NPI assigned
Jul 11, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2024

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

Authorized official

Name
Pamela Bower
Title
Ceo
Phone
(646) 271-0212

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208800000X Primary

Addresses

Primary practice location

1941 SE Port St Lucie Blvd
Port St Lucie, FL 34952-5535

Mailing address

1941 SE Port St Lucie Blvd
Port St Lucie, FL 34952-5535
Phone (772) 340-6777

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230816002040 FL Part B Supplier - Clinic/Group Practice 3476915802 Receives reassigned benefits from 2 practitioners
Practice locations: Fort Pierce, FL; Port St Lucie, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2289946Bower Urology LLC1941 SE Port St Lucie Blvd, Port Saint Lucie, FL 34952Certificate of waiverSep 17, 2027

National Provider Directory

National Provider Directory

Locations

2401 Frist Blvd
Ste 2
Fort Pierce, FL 34950
Phone (772) 465-1500

1941 SE Port St Lucie Blvd
Port St Lucie, FL 34952
Phone (772) 340-6777

Practitioners & affiliated clinicians

Practitioners 2

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": "1689033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716940800000",
    "number": "1467130294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1941 SE PORT ST LUCIE BLVD",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349525535",
            "telephone_number": "772-340-6777",
            "fax_number": "772-236-3002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1941 SE PORT ST LUCIE BLVD",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349525535",
            "telephone_number": "772-340-6777",
            "fax_number": "772-236-3002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOWER UROLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-11",
        "last_updated": "2024-05-29",
        "certification_date": "2023-11-01",
        "status": "A",
        "authorized_official_last_name": "BOWER",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "646-271-0212"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port St Lucie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.