Interactivemd LLC

Primary specialty

Diabetes Educator Registered NurseTaxonomy code 163WD0400X

Legal business name

INTERACTIVEMD LLC

Practice address

5300 Broken Sound Blvd NW
Suite 200
Boca Raton, FL 33487-3520

Phone

(888) 657-2560

Fax

(561) 998-2057

NPI assigned

Aug 1, 2012

Organization subpart

Yes

Parent organization

ONCALL ONLINE LLCAs reported in NPPES

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

Authorized official

Name

Mr. Gary Wald, MBA

Title

Chief Operating Officer

Phone

(888) 657-2560

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1343779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343779200000",
    "number": "1790031300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5300 BROKEN SOUND BLVD NW",
            "address_2": "SUITE 200",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334873520",
            "telephone_number": "888-657-2560",
            "fax_number": "561-998-2057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5300 BROKEN SOUND BLVD NW",
            "address_2": "SUITE 200",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334873520",
            "telephone_number": "888-657-2560",
            "fax_number": "561-998-2057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERACTIVEMD LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ONCALL ONLINE LLC",
        "enumeration_date": "2012-08-01",
        "last_updated": "2012-08-01",
        "status": "A",
        "authorized_official_last_name": "WALD",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "888-657-2560",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "133VN1006X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WD0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Diabetes Educator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.