Active NPI
Palm Beach Neurology
- Clinical Neurophysiology Physician
- West Palm Beach, FL
National Provider Identifier
1710133467
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neurophysiology Physician
- Legal business name
- PALM BEACH NEUROLOGY
- Practice address
- 2151 45TH Street
102
West Palm Beach, FL 33407 - Phone
- (561) 296-4120
- Fax
- (561) 296-3657
- NPI assigned
- Aug 13, 2008
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Chris Polanco
- Title
- Billing Manager
- Phone
- (561) 296-3851
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neurophysiology Physician | 2084N0600X | Primary |
Addresses
Primary practice location
2151 45TH Street
102
West Palm Beach, FL 33407
Mailing address
4631 North Congress Ave
200
West Palm Beach, FL 33407
Phone (561) 845-0500
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040330001221 | FL | Part B Supplier - Clinic/Group Practice | 5698767887 |
Receives reassigned benefits from 13 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Royal Palm Beach, FL; West Palm Beach, FL |
Other NPIs on the same Medicare enrollment 3
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1218585600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1267488000000",
"number": "1710133467",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4631 NORTH CONGRESS AVE",
"address_2": "200",
"city": "WEST PALM BEACH",
"state": "FL",
"postal_code": "33407",
"telephone_number": "561-845-0500",
"fax_number": "561-296-1101"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2151 45TH STREET",
"address_2": "102",
"city": "WEST PALM BEACH",
"state": "FL",
"postal_code": "33407",
"telephone_number": "561-296-4120",
"fax_number": "561-296-3657"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PALM BEACH NEUROLOGY",
"organizational_subpart": "NO",
"enumeration_date": "2008-08-13",
"last_updated": "2010-03-02",
"status": "A",
"authorized_official_last_name": "POLANCO",
"authorized_official_first_name": "CHRIS",
"authorized_official_title_or_position": "BILLING MANAGER",
"authorized_official_telephone_number": "561-296-3851",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "2084N0600X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychiatry & Neurology, Clinical Neurophysiology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Palm Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2010; 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.