NPIMap

Organization Active NPI

Providers Health Alliance, LLC

  • Internal Medicine Physician
  • Loxahatchee, FL
National Provider Identifier
1689064834
Registry record updated Sep 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PROVIDERS HEALTH ALLIANCE, LLC
Practice address
12955 Palms West Dr Ste 203
Loxahatchee, FL 33470-9217
Phone
(561) 231-5200
Fax
(561) 231-5201
NPI assigned
Jan 27, 2015
Last updated
Sep 9, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2020

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

Authorized official

Name
Mrs. Tina Dochniak, DNPNPI 1427094937
Title
President
Phone
(561) 293-4305

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
Internal Medicine Physician 207R00000X Primary

Addresses

Primary practice location

12955 Palms West Dr Ste 203
Loxahatchee, FL 33470-9217

Mailing address

11924 Forest Hill Blvd Ste 10a-138
Wellington, FL 33414-6256
Phone (561) 293-4301

Other practice location 1

6056 Boynton Beach Blvd Ste 115
Boynton Beach, FL 33437
Phone (561) 708-1760

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170215002570 FL Part B Supplier - Clinic/Group Practice 9739462813 Receives reassigned benefits from 16 practitioners
Practice locations: Boynton Beach, FL; Delray Beach, FL; Lake Clarke Shores, FL; Loxahatchee, FL; Royal Palm Beach, FL

National Provider Directory

National Provider Directory

Locations

9868 S State Road 7
Ste 215
Boynton Beach, FL 33472
Phone (561) 600-9716

9868 S State Road 7
Ste 310
Boynton Beach, FL 33472
Phone (561) 708-1760

13590 S Jog Rd
Ste 4
Delray Beach, FL 33446
Phone (561) 396-1538

1025 Military Trl
Ste 200
Jupiter, FL 33458
Phone (561) 575-2000

11924 Forest Hill Blvd
Ste 10A413
Wellington, FL 33414

Practitioners & affiliated clinicians

Practitioners 18

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.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1422316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599609600000",
    "number": "1689064834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11924 FOREST HILL BLVD STE 10A-138",
            "city": "WELLINGTON",
            "state": "FL",
            "postal_code": "334146256",
            "telephone_number": "561-293-4301",
            "fax_number": "561-828-3111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12955 PALMS WEST DR STE 203",
            "city": "LOXAHATCHEE",
            "state": "FL",
            "postal_code": "334709217",
            "telephone_number": "561-231-5200",
            "fax_number": "561-231-5201"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6056 Boynton Beach Blvd Ste 115",
            "address_purpose": "LOCATION",
            "city": "Boynton Beach",
            "state": "FL",
            "postal_code": "33437",
            "country_code": "US",
            "telephone_number": "561-708-1760",
            "fax_number": "561-469-9375",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROVIDERS HEALTH ALLIANCE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-27",
        "last_updated": "2020-09-09",
        "certification_date": "2020-09-09",
        "status": "A",
        "authorized_official_last_name": "DOCHNIAK",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "561-293-4305",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "DNP"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loxahatchee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2020; 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.