NPIMap

Organization Active NPI

Soma Medical Center, PA #4

  • Pediatrics Physician
  • West Palm Beach, FL
National Provider Identifier
1568912699
Registry record updated Apr 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME102127 Issued in FL
Legal business name
SOMA MEDICAL CENTER, PA #4
Practice address
4623 Forest Hill Blvd
Suite 112
West Palm Beach, FL 33415-7469
Phone
(561) 433-0080
Fax
(561) 433-1668
NPI assigned
Oct 13, 2016
Last updated
Apr 2, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
SOMA MEDICAL CENTER, PA #4As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 2, 2021

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

Authorized official

Name
Lina Niemczyk Niemczyk
Title
Office Manager
Phone
(561) 433-0080

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X ME102127 FL Primary

Addresses

Primary practice location

4623 Forest Hill Blvd
Suite 112
West Palm Beach, FL 33415-7469

Mailing address

4623 Forest Hill Blvd
Suite 112
West Palm Beach, FL 33415-7469
Phone (561) 433-0080

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
10D2050582Soma Medical Center PA #44623 Forest Hill Blvd Ste 112, West Palm Beach, FL 33415Certificate of waiverDec 2, 2026

National Provider Directory

National Provider Directory
Tax ID family
Soma Medical Center PA 48 organizations share this tax ID, including this one
Part of
Soma Medical Center PA 4

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1170 SW Bayshore Blvd
Ste 100
Port St Lucie, FL 34983
Phone (561) 281-4707

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1476316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617321600000",
    "number": "1568912699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4623 FOREST HILL BLVD",
            "address_2": "SUITE 112",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334157469",
            "telephone_number": "561-433-0080",
            "fax_number": "561-433-1668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4623 FOREST HILL BLVD",
            "address_2": "SUITE 112",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334157469",
            "telephone_number": "561-433-0080",
            "fax_number": "561-433-1668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOMA MEDICAL CENTER, PA #4",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOMA MEDICAL CENTER, PA #4",
        "enumeration_date": "2016-10-13",
        "last_updated": "2021-04-02",
        "certification_date": "2021-04-02",
        "status": "A",
        "authorized_official_last_name": "NIEMCZYK",
        "authorized_official_first_name": "LINA NIEMCZYK",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "561-433-0080"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME102127",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Palm Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.