NPIMap

Organization Active NPI

Palm Beach Pathology, PA

Doing business as Palm Beach Gardens Pathology Assocciates

  • Anatomic Pathology & Clinical Pathology Physician
  • Palm Beach Gardens, FL
National Provider Identifier
1720253198
Registry record updated Sep 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
PALM BEACH PATHOLOGY, PA
Doing business as
Palm Beach Gardens Pathology Assocciates
Practice address
3360 Burns Rd
Palm Beach Gardens, FL 33410-4323
Phone
(954) 240-9555
NPI assigned
Apr 28, 2008
Last updated
Sep 20, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2010

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

Authorized official

Name
Thomas A Bolton, MDNPI 1871574665
Title
President
Phone
(954) 240-9555

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
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ZP0102X Primary

Addresses

Primary practice location

3360 Burns Rd
Palm Beach Gardens, FL 33410-4323

Mailing address

PO Box 4117
West Palm Beach, FL 33402-4117
Phone (954) 240-9555

Other identifiers 2

IdentifierTypeStateIssuer
258264300MedicaidFL
97880OtherFLBLUE CROSS BLUE SHIELD

Other names 1

  • Palm Beach Gardens Pathology Assocciates Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040914001153 FL Part B Supplier - Clinic/Group Practice 1658350350 Receives reassigned benefits from 8 practitioners
Practice locations: Palm Beach Gardens, FL

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Palm Beach Pathology PA8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2013 Ponce de Leon Ave
West Palm Beach, FL 33407
Phone (561) 659-0770

Practitioners & affiliated clinicians

Practitioners 10

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": "1209340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284940800000",
    "number": "1720253198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4117",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334024117",
            "telephone_number": "954-240-9555",
            "fax_number": "770-776-5966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3360 BURNS RD",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334104323",
            "telephone_number": "954-240-9555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALM BEACH PATHOLOGY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-28",
        "last_updated": "2010-09-20",
        "status": "A",
        "authorized_official_last_name": "BOLTON",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "954-240-9555",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "258264300",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "97880",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Palm Beach Gardens Pathology Assocciates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Palm Beach Gardens, FL

Sources for this page

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

Verify at the official NPI Registry.