Northwest Florida ENT PA

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

ME96773 Issued in FL

Legal business name

NORTHWEST FLORIDA ENT PA

Practice address

310 Racetrack Rd NW Ste 100
Fort Walton Beach, FL 32547-1553

Phone

(850) 889-4550

Fax

(850) 889-4549

NPI assigned

Sep 12, 2015

Organization subpart

No

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

Authorized official

Name

Jason Redwood Boole

Title

President

Phone

(850) 889-4550

Specialties & licenses 3

Addresses

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/12172/brand/1/csg/1/fhir/r4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Valeria A Amaya

  • Behavior Technician
  • Lilburn, GA
  • NPI 1336070069
  NPD
• Matthew Wisniewski, PTA

  • Physical Therapist
  • Fort Walton Beach, FL
  • NPI 1659855567
  NPD (past)

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

{
    "created_epoch": "1442016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555113600000",
    "number": "1821466491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 RACETRACK RD NW",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325471553",
            "telephone_number": "850-889-4550",
            "fax_number": "850-807-5217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 RACETRACK RD NW STE 100",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325471553",
            "telephone_number": "850-889-4550",
            "fax_number": "850-889-4549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST FLORIDA ENT PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-12",
        "last_updated": "2019-04-13",
        "status": "A",
        "authorized_official_last_name": "BOOLE",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "REDWOOD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "850-889-4550"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": "FL",
            "license": "ME96773",
            "primary": true
        },
        {
            "code": "207YS0012X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Otolaryngology, Sleep Medicine",
            "state": "FL",
            "license": "ME96773",
            "primary": false
        },
        {
            "code": "207YX0602X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Otolaryngology, Otolaryngic Allergy",
            "state": "FL",
            "license": "ME96773",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• North Florida Surgeons, PA
• North Florida Surgeons, PA
• North Florida Surgeons, PA
• North Florida Surgeons, PA
• Northland Hearing Center, Inc.
• Northwest Florida Multispecialty Physicians LLC
• Northwest Florida Multispecialty Physicians LLC
• Northwest Florida Sleep LLC
• Northwest Florida Womens Cancer Care LLC
• Abbie Camille Santos Nucup, MD

• All providers in Fort Walton Beach, FL
• Otolaryngology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2019; 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.