Emerald Intraoperative Neuromonitoring , PLLC

Primary specialty

Clinical Neurophysiology PhysicianTaxonomy code 2084N0600X

Legal business name

EMERALD INTRAOPERATIVE NEUROMONITORING , PLLC

Practice address

7643 Gate Pkwy # 104-983
Jacksonville, FL 32256-2893

Phone

(866) 374-6628

Fax

(866) 951-1120

NPI assigned

Jul 28, 2020

Last updated

Apr 5, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kelly McClintock

Title

Compliance Officer

Phone

(866) 374-6628

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1595894400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649116800000",
    "number": "1548879364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7643 GATE PKWY # 104-983",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322562893",
            "telephone_number": "866-374-6628",
            "fax_number": "866-951-1120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7643 GATE PKWY # 104-983",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322562893",
            "telephone_number": "866-374-6628",
            "fax_number": "866-951-1120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMERALD INTRAOPERATIVE NEUROMONITORING , PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-28",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-05",
        "status": "A",
        "authorized_official_last_name": "MCCLINTOCK",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "866-374-6628"
    },
    "taxonomies": [
        {
            "code": "2084N0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2022; 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.