NPIMap

Organization Active NPI

Soma Medical Center .PA #6

  • Primary Care Clinic/Center
  • Boynton Beach, FL
National Provider Identifier
1609449362
Registry record updated Jan 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
SOMA MEDICAL CENTER .PA #6
Practice address
4775 N Congress Ave
Boynton Beach, FL 33426-7941
Phone
(561) 328-8631
Fax
(561) 557-4910
NPI assigned
Jul 21, 2021
Organization subpart
Yes
Parent organization
SOMA MEDICAL CENTER #6As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 18, 2022

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

Authorized official

Name
Rafael O Nunez, M.D.
Title
Medical Director/Owner
Phone
(561) 530-4112

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

4775 N Congress Ave
Boynton Beach, FL 33426-7941

Mailing address

3580 Lake Worth Rd
Lake Worth, FL 33461

Other identifiers 1

IdentifierTypeStateIssuer
01434400MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220823000192 FL Part B Supplier - Clinic/Group Practice 6406239540 Receives reassigned benefits from 7 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Boynton Beach, FL; Palm Springs, FL

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
10D2228699Soma Medical Center PA 64775 N Congress Ave, Boynton Beach, FL 33426Certificate of waiverJun 29, 2027

National Provider Directory

National Provider Directory
Tax ID family
Soma Medical Center PA 62 organizations share this tax ID, including this one
Part of
Soma Medical Center PA 6

Other organizations with this tax ID 1

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

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 8

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": "1626825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642464000000",
    "number": "1609449362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3580 LAKE WORTH RD",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "33461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4775 N CONGRESS AVE",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334267941",
            "telephone_number": "561-328-8631",
            "fax_number": "561-557-4910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOMA MEDICAL CENTER .PA #6",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOMA MEDICAL CENTER #6",
        "enumeration_date": "2021-07-21",
        "last_updated": "2022-01-18",
        "certification_date": "2022-01-18",
        "status": "A",
        "authorized_official_last_name": "NUNEZ",
        "authorized_official_first_name": "RAFAEL",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR/OWNER",
        "authorized_official_telephone_number": "561-530-4112",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01434400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boynton Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2022; 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.