Seacrest Medical Group PA

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

ME94948 Issued in FL

Legal business name

SEACREST MEDICAL GROUP PA

Doing business as

Seacrest Medical Office Diagnostic

Practice address

2848 S Seacrest Blvd
Boynton Beach, FL 33435-7935

Phone

(561) 738-7611

Fax

(561) 738-7622

NPI assigned

Jun 1, 2007

Organization subpart

No

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

Authorized official

Name

Jean Richard Etienne, MDNPI 1801806658

Title

Physician

Phone

(561) 738-7611

Specialties & licenses 1

Addresses

Other names 1

• SEACREST MEDICAL OFFICE DIAGNOSTIC Doing business as

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

Practitioners 1

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

• Jean Richard Etienne, M.D.

  • Internal Medicine Physician
  • Boynton Beach, FL
  • NPI 1801806658
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1180656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602633600000",
    "number": "1700088911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2848 S SEACREST BLVD",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334357935",
            "telephone_number": "561-738-7611",
            "fax_number": "561-738-7622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2848 S SEACREST BLVD",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334357935",
            "telephone_number": "561-738-7611",
            "fax_number": "561-738-7622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEACREST MEDICAL GROUP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-01",
        "last_updated": "2020-10-14",
        "certification_date": "2020-10-14",
        "status": "A",
        "authorized_official_last_name": "ETIENNE",
        "authorized_official_first_name": "JEAN",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "561-738-7611",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME94948",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SEACREST MEDICAL OFFICE DIAGNOSTIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Scott Friedberg DO PA
• Scott R English MD PA
• April Scott, PHARMD
• Kaile Jo Scott
• Scripts for Life, Inc (Seacrest Pharmacy)
• Seacrest Recovery, LLC
• Seacrest Residence LLC
• Seacrest Surgical Center LLC
• Seacrest Transitional Living
• Seaglass Wellness Group

• Internal Medicine Physician in Boynton Beach, FL
• Providers in Boynton Beach, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2020; 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.