Organization Active NPI

Christopher J Prusinski DO PA

  • Neurology Physician
  • Melbourne, FL
National Provider Identifier
1700063708
Registry record updated Feb 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
OS0005640 Issued in FL
Legal business name
CHRISTOPHER J PRUSINSKI DO PA
Practice address
1310 W Eau Gallie Blvd
Suite B
Melbourne, FL 32935-5300
Phone
(321) 421-6566
Fax
(321) 421-6572
NPI assigned
Jan 22, 2008
Last updated
Feb 20, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2008

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

Authorized official

Name
Christopher J Prusinski, DONPI 1467556779
Title
Physician
Phone
(321) 421-6566

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
Neurology Physician 2084N0400X OS0005640 FL Primary

Addresses

Primary practice location

1310 W Eau Gallie Blvd
Suite B
Melbourne, FL 32935-5300

Mailing address

1310 W Eau Gallie Blvd
Suite B
Melbourne, FL 32935-5300
Phone (321) 421-6566

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080311000264 FL Part B Supplier - Clinic/Group Practice 0547345803 Receives reassigned benefits from 2 practitioners
Practice locations: Melbourne, FL

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
10D2285178Christopher J Prusinski DO PA1310 W Eau Gallie Boulevard Suite B, Melbourne, FL 32935Certificate of waiverJul 6, 2027

National Provider Directory

National Provider Directory

Locations

1310 W Eau Gallie Blvd
Ste B
Melbourne, FL 32935
Phone (321) 421-6566

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BJDJCD

Practitioners & affiliated clinicians

Practitioners 2

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": "1200960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203465600000",
    "number": "1700063708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1310 W EAU GALLIE BLVD",
            "address_2": "SUITE B",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329355300",
            "telephone_number": "321-421-6566",
            "fax_number": "321-421-6572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 W EAU GALLIE BLVD",
            "address_2": "SUITE B",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329355300",
            "telephone_number": "321-421-6566",
            "fax_number": "321-421-6572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRISTOPHER J PRUSINSKI DO PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-22",
        "last_updated": "2008-02-20",
        "status": "A",
        "authorized_official_last_name": "PRUSINSKI",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "321-421-6566",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "FL",
            "license": "OS0005640",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Melbourne, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2008; 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.