NPIMap

Organization Active NPI

Irecovery, LLC

  • Addiction Medicine (Preventive Medicine) Physician
  • Fort Pierce, FL
National Provider Identifier
1851964407
Registry record updated Sep 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Preventive Medicine) PhysicianTaxonomy code 2083A0300X
Legal business name
IRECOVERY, LLC
Practice address
130 S Indian River Dr Ste 202-6405
Fort Pierce, FL 34950-4343
Phone
(772) 773-6989
Fax
(561) 464-5501
NPI assigned
Jul 21, 2021
Organization subpart
Yes
Parent organization
IRECOVERY, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 27, 2021

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

Authorized official

Name
Mildred Cintron
Title
Credentialing Specialist
Phone
(561) 235-7683

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Medicine (Preventive Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2083A0300X Primary

Addresses

Primary practice location

130 S Indian River Dr Ste 202-6405
Fort Pierce, FL 34950-4343

Mailing address

5030 Champion Blvd Ste G11-535
Boca Raton, FL 33496-2473
Phone (561) 235-7683

Other identifiers 1

IdentifierTypeStateIssuer
1107100606MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200409000862 FL Part B Supplier - Clinic/Group Practice 3476982638 Receives reassigned benefits from 11 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Miami, FL; Orlando, FL; Ocala, FL; Pensacola, FL; Plant City, FL; Sarasota, FL; St Petersburg, FL; Tallahassee, FL…

Other NPIs on the same Medicare enrollment 15

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 15

National Provider Directory

National Provider Directory
Tax ID family
Irecovery LLC25 organizations share this tax ID, including this one
Part of
Irecovery LLC

Other organizations with this tax ID 24

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

View all 24

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1626825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632700800000",
    "number": "1851964407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5030 CHAMPION BLVD STE G11-535",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334962473",
            "telephone_number": "561-235-7683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 S INDIAN RIVER DR STE 202-6405",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349504343",
            "telephone_number": "772-773-6989",
            "fax_number": "561-464-5501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IRECOVERY, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IRECOVERY, LLC",
        "enumeration_date": "2021-07-21",
        "last_updated": "2021-09-27",
        "certification_date": "2021-09-27",
        "status": "A",
        "authorized_official_last_name": "CINTRON",
        "authorized_official_first_name": "MILDRED",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "561-235-7683"
    },
    "taxonomies": [
        {
            "code": "2083A0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1107100606",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Pierce, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2021; 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.