NPIMap

Organization Active NPI

PCP 1St

  • Nurse Practitioner
  • Boca Raton, FL
National Provider Identifier
1710515564
Registry record updated Mar 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
PCP 1ST
Doing business as
PCP 1st
Practice address
17188 Newport Club Dr
Boca Raton, FL 33496-3009
Phone
(954) 803-3564
NPI assigned
Mar 28, 2020
Last updated
Mar 28, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2020

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

Authorized official

Name
Yeeny GonzalezNPI 1538227616
Title
President
Phone
(954) 803-3564

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
Nurse Practitioner 363L00000X Primary

Addresses

Primary practice location

17188 Newport Club Dr
Boca Raton, FL 33496-3009

Mailing address

2901 Clint Moore Rd # 119
Boca Raton, FL 33496-2041
Phone (954) 803-3564

Other names 1

  • PCP 1st Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL CVS Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200414000027 FL Part B Supplier - Clinic/Group Practice 5991135022 Receives reassigned benefits from 7 practitioners
Practice locations: Boca Raton, FL

National Provider Directory

National Provider Directory

Locations

1050 NW 15th St
Ste 205A
Boca Raton, FL 33486
Phone (407) 393-8224

2901 Clint Moore Rd
#119
Boca Raton, FL 33496

Practitioners & affiliated clinicians

Practitioners 7

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": "1585353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585353600000",
    "number": "1710515564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 CLINT MOORE RD # 119",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334962041",
            "telephone_number": "954-803-3564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17188 NEWPORT CLUB DR",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334963009",
            "telephone_number": "954-803-3564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PCP 1ST",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-28",
        "last_updated": "2020-03-28",
        "certification_date": "2020-03-28",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "YEENY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "954-803-3564"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "CVS",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2901 Clint Moore Rd # 119",
            "city": "Boca Raton",
            "state": "FL",
            "country_code": "US",
            "postal_code": "334962041",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "PCP 1st",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boca Raton, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 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.