Active NPI
Suzanne M. Bertollo, M.D., MPH
- Public Health & General Preventive Medicine Physician
- Boca Raton, FL
National Provider Identifier
1871542902
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Public Health & General Preventive Medicine Physician
- License
- ME144621
- Practice address
- 777 Glades Rd # BC71
Boca Raton, FL 33431-6424 - Phone
- (561) 297-3622
- NPI assigned
- May 8, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | ME144621 | FL | |
| Emergency Medicine Physician | 207P00000X | 9700023 | NC | |
| Emergency Medicine Physician | 207P00000X | 30296 | SC | |
| Public Health & General Preventive Medicine Physician | 2083P0901X | ME144621 | FL | Primary |
| Public Health & General Preventive Medicine Physician | 2083P0901X | 30296 | SC |
Addresses
Primary practice location
777 Glades Rd # BC71
Boca Raton, FL 33431-6424
Mailing address
777 Glades Rd # BC-71
Boca Raton, FL 33431-6424
Phone (561) 297-3622
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AA22522353 | Other | SC | MEDICARE PTAN |
| N00023 | Medicaid | SC | |
| 79-10976 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME144621 | FL | MD | Emergency Medicine Physician |
| 9700023 | NC | MD | Emergency Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147046400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1624838400000",
"number": "1871542902",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "777 GLADES RD # BC-71",
"city": "BOCA RATON",
"state": "FL",
"postal_code": "334316424",
"telephone_number": "561-297-3622"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "777 GLADES RD # BC71",
"city": "BOCA RATON",
"state": "FL",
"postal_code": "334316424",
"telephone_number": "561-297-3622"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERTOLLO",
"first_name": "SUZANNE",
"middle_name": "M.",
"credential": "M.D., MPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-08",
"last_updated": "2021-06-28",
"certification_date": "2021-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "FL",
"license": "ME144621",
"primary": false
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "NC",
"license": "9700023",
"primary": false
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "SC",
"license": "30296",
"primary": false
},
{
"code": "2083P0901X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Public Health & General Preventive Medicine",
"state": "FL",
"license": "ME144621",
"primary": true
},
{
"code": "2083P0901X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Public Health & General Preventive Medicine",
"state": "SC",
"license": "30296",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "AA22522353",
"state": "SC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "N00023",
"state": "SC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "79-10976",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boca Raton, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.