Individual provider Active NPI

Wyslaine Lamontagne, MD

  • Internal Medicine Physician
  • Palm Beach Gardens, FL
National Provider Identifier
1811182918
Registry record updated Jan 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME104209 Issued in FL
Practice address
4212 Northlake Blvd
Palm Beach Gardens, FL 33410-6252
Phone
(561) 841-6252
Fax
(561) 841-6260
NPI assigned
Sep 11, 2007
Last updated
Jan 6, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 253505 NY
Internal Medicine Physician 207R00000X ME104209 FL Primary

Addresses

Primary practice location

4212 Northlake Blvd
Palm Beach Gardens, FL 33410-6252

Mailing address

4212 Northlake Blvd
Palm Beach Gardens, FL 33410-6252
Phone (561) 841-6252

Other identifiers 2

IdentifierTypeStateIssuer
001851700MedicaidFL
03124756MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111205000854 FL Practitioner - Internal Medicine 6103970876 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

4212 Northlake Blvd
Palm Beach Gardens, FL 33410-6252
Phone (561) 841-6252

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME104209FLMDInternal Medicine Physician
253505NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Grace Medical Center of Florida, Inc. Internal Medicine CurrentSince Jan 1, 2014 Accepting new patients
Crestview Hospital Company, LLC CurrentSince Nov 8, 2011 Accepting new patients
Crestview Hospital Company LLC Internal Medicine CurrentSince Nov 8, 2011 Accepting new patients
Cogent Healthcare of New Jersey, PC Internal Medicine Past Accepting new patients

Locations

151 E Redstone Ave
Crestview, FL 32539
Phone (850) 629-8515

4212 Northlake Blvd
Palm Beach Gardens, FL 33410
Phone (561) 627-2821

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JHCCDA
  • FHIR API: https://fhir4.healow.com/fhir/r4/JHCCDA/Endpoint/JHCCDA

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1189468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1388966400000",
    "number": "1811182918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4212 NORTHLAKE BLVD",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334106252",
            "telephone_number": "561-841-6252",
            "fax_number": "561-841-6260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4212 NORTHLAKE BLVD",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334106252",
            "telephone_number": "561-841-6252",
            "fax_number": "561-841-6260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAMONTAGNE",
        "first_name": "WYSLAINE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-11",
        "last_updated": "2014-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "253505",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME104209",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001851700",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03124756",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Beach Gardens, FL

Sources for this page

Verify at the official NPI Registry.