Charles S Theofilos, M.D. P.A.

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

License

ME0064328 Issued in FL

Practice address

300 Village Square Xing Ste 202
Palm Beach Gardens, FL 33410-3223

Phone

(561) 630-3870

Fax

(561) 630-3680

NPI assigned

May 17, 2006

Last updated

Jun 18, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Physician Assistant

Practice roles

Interoperability endpoints

• Direct secure messaging: charles.theofilosmd.p1@direct.thespinecenter.nextgenshare.com

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.

• Charles S. Theofilos MD PA

  dba The Spine Center

  • Neurological Surgery Physician
  • Palm Beach Gardens, FL
  • NPI 1841242823
  Authorized official Same address or phone
• Charles S Theofilos MD

  • Non-Pharmacy Dispensing Site
  • Palm Beach Gardens, FL
  • NPI 1760408611
  NPD (past)

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623974400000",
    "number": "1861444846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 VILLAGE SQUARE XING STE 202",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334103223",
            "telephone_number": "561-630-3870",
            "fax_number": "561-630-3680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 VILLAGE SQUARE XING STE 202",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334103223",
            "telephone_number": "561-630-3870",
            "fax_number": "561-630-3680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEOFILOS",
        "first_name": "CHARLES",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "M.D. P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-17",
        "last_updated": "2021-06-18",
        "certification_date": "2021-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "FL",
            "license": "ME0064328",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "373280100",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "NextGen",
            "affiliation": "N",
            "address_1": "300 Village Square Xing Ste 202",
            "city": "Palm Beach Gardens",
            "state": "FL",
            "country_code": "US",
            "postal_code": "334103223",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Neurological Surgery Physician in Palm Beach Gardens, FL
• Providers in Palm Beach Gardens, FL by specialty
• Neurological Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.