Brain and Spine Institute of Port Orange, LLC

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

ME80334 Issued in FL

Legal business name

BRAIN AND SPINE INSTITUTE OF PORT ORANGE, LLC

Practice address

1211 Dunlawton Ave
Port Orange, FL 32127-2913

Phone

(386) 304-0111

NPI assigned

Mar 12, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Timothy Joseph Wierzbicki, M.D.NPI 1134145741

Title

Ceo

Phone

(386) 304-0111

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/8504/brand/1/csg/1/fhir/r4

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Timothy J Wierzbicki, MD

  • Neurology Physician
  • Port Orange, FL
  • NPI 1134145741
  Medicare reassignment NPD Authorized official
• Pradyumansinh M Chudasama, MD

  • Internal Medicine Physician
  • Port Orange, FL
  • NPI 1306827027
  NPD (past)

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

{
    "created_epoch": "1363046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363305600000",
    "number": "1699016949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1211 DUNLAWTON AVE",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321272913",
            "telephone_number": "386-304-0111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1211 DUNLAWTON AVE",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321272913",
            "telephone_number": "386-304-0111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAIN AND SPINE INSTITUTE OF PORT ORANGE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-12",
        "last_updated": "2013-03-15",
        "status": "A",
        "authorized_official_last_name": "WIERZBICKI",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "386-304-0111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "FL",
            "license": "ME80334",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "259058100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "130022355",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Bostic
• Rody Georges Bou Chaaya, MD
• Ashley Bowersox
• Margaret J. Bows, COTA
• Heather Leigh Bowyer, D.C.
• Brain Health Solutions, LLC
• Jim Branch, PH.D.
• Raynard Brant, RBT
• Beatrice Bratu, MD
• Breeze Aesthetics, Inc

• Neurology Physician in Port Orange, FL
• Providers in Port Orange, FL by specialty
• Neurology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2013; 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.