NPIMap

Organization Active NPI

Pure Age Management LLC

  • Internal Medicine Physician
  • Boynton Beach, FL
National Provider Identifier
1669832341
Registry record updated Feb 24, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME83769 Issued in FL
Legal business name
PURE AGE MANAGEMENT LLC
Practice address
1054 Gateway Blvd
Suite 103
Boynton Beach, FL 33426-8301
Phone
(561) 847-4654
Fax
(561) 847-4956
NPI assigned
Feb 24, 2016
Last updated
Feb 24, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2016

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

Authorized official

Name
Mr. Karl E Vaeth
Title
Owner/Managing Partner
Phone
(561) 225-9922

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X ME83769 FL Primary
Clinical & Laboratory Immunology (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RI0001X ME83769 FL
Obesity Medicine (Preventive Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2083B0002X ME83769 FL
Medical Toxicology (Preventive Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2083T0002X ME83769 FL
Clinical Medical Laboratory 291U00000X 10D2100646 FL
Medical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AM0700X PA9106969 FL

Addresses

Primary practice location

1054 Gateway Blvd
Suite 103
Boynton Beach, FL 33426-8301

Mailing address

1054 Gateway Blvd
Suite 103
Boynton Beach, FL 33426-8301
Phone (561) 847-4654

National Provider Directory

National Provider Directory

Locations

1054 Gateway Blvd
Ste 103
Boynton Beach, FL 33426
Phone (561) 847-4654

Practitioners & affiliated clinicians

Practitioners 4

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": "1456272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456272000000",
    "number": "1669832341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1054 GATEWAY BLVD",
            "address_2": "SUITE 103",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334268301",
            "telephone_number": "561-847-4654",
            "fax_number": "561-847-4956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1054 GATEWAY BLVD",
            "address_2": "SUITE 103",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334268301",
            "telephone_number": "561-847-4654",
            "fax_number": "561-847-4956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PURE AGE MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-24",
        "last_updated": "2016-02-24",
        "status": "A",
        "authorized_official_last_name": "VAETH",
        "authorized_official_first_name": "KARL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER/MANAGING PARTNER",
        "authorized_official_telephone_number": "561-225-9922",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME83769",
            "primary": true
        },
        {
            "code": "207RI0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Clinical & Laboratory Immunology",
            "state": "FL",
            "license": "ME83769",
            "primary": false
        },
        {
            "code": "2083B0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Obesity Medicine",
            "state": "FL",
            "license": "ME83769",
            "primary": false
        },
        {
            "code": "2083T0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Medical Toxicology",
            "state": "FL",
            "license": "ME83769",
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "FL",
            "license": "10D2100646",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9106969",
            "primary": false
        }
    ],
    "identifiers": [],
    "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 Feb 24, 2016; 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.