NPIMap

Organization Active NPI

Vital Wound Care LLC

  • General Practice Physician
  • West Palm Beach, FL
National Provider Identifier
1669296687
Registry record updated Nov 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
VITAL WOUND CARE LLC
Practice address
1749 N Military TRL Ste a
West Palm Beach, FL 33409-4769
Phone
(561) 247-4462
NPI assigned
Nov 15, 2024
Last updated
Nov 15, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2024

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

Authorized official

Name
Nerlyn JestineNPI 1457705618
Title
Ceo
Phone
(561) 460-2464

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

1749 N Military TRL Ste a
West Palm Beach, FL 33409-4769

Mailing address

1749 N Military TRL Ste a
West Palm Beach, FL 33409-4769

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250715000706 FL Part B Supplier - Clinic/Group Practice 0143735506 Receives reassigned benefits from 1 practitioner
Practice locations: West Palm Beach, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

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": "1731628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731628800000",
    "number": "1669296687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1749 N MILITARY TRL STE A",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334094769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1749 N MILITARY TRL STE A",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334094769",
            "telephone_number": "561-247-4462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITAL WOUND CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-15",
        "last_updated": "2024-11-15",
        "certification_date": "2024-11-15",
        "status": "A",
        "authorized_official_last_name": "JESTINE",
        "authorized_official_first_name": "NERLYN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "561-460-2464"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "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 Nov 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.