Individual provider Active NPI

Pavel Tulisov

  • Counselor
  • Pompano Beach, FL
National Provider Identifier
1548818354
Registry record updated Nov 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
MH26635 Issued in FL
Practice address
817 N Dixie Hwy
Pompano Beach, FL 33060-5621
Phone
(954) 785-8285
NPI assigned
Aug 27, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X MH26635 FL Primary

Addresses

Primary practice location

817 N Dixie Hwy
Pompano Beach, FL 33060-5621

Mailing address

817 N Dixie Hwy
Pompano Beach, FL 33060-5621

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260317000993 FL Practitioner - Mental Health Counselor 6608359732 Reassigns benefits to 1 organization
Practice locations: Greenacres, FL

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3504 Mill Brook Way Cir
Greenacres, FL 33463-3055
Phone (561) 895-9514

66 E Flagler St
Miami, FL 33130-1807

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
MH26635FLMDCounselor

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1566864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764288000000",
    "number": "1548818354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "817 N DIXIE HWY",
            "city": "POMPANO BEACH",
            "state": "FL",
            "postal_code": "330605621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "817 N DIXIE HWY",
            "city": "POMPANO BEACH",
            "state": "FL",
            "postal_code": "330605621",
            "telephone_number": "954-785-8285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TULISOV",
        "first_name": "PAVEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-27",
        "last_updated": "2025-11-28",
        "certification_date": "2025-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "FL",
            "license": "MH26635",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pompano Beach, FL

Sources for this page

Verify at the official NPI Registry.