NPIMap

Organization Active NPI

Palm Beach Surgical Associates

  • Surgery Physician
  • Atlantis, FL
National Provider Identifier
1902930795
Registry record updated Jun 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
PALM BEACH SURGICAL ASSOCIATES
Practice address
120 JFK Dr Ste 120
Atlantis, FL 33462-6623
Phone
(561) 331-0808
Fax
(561) 594-0880
NPI assigned
Mar 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2022

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

Authorized official

Name
Agustin Ibarrola, M.D.NPI 1043206600
Title
Owner
Phone
(561) 331-0808

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

120 JFK Dr Ste 120
Atlantis, FL 33462-6623

Mailing address

6415 Lake Worth Rd Ste 102
Greenacres, FL 33463-3009
Phone (561) 331-0808

Other identifiers 2

IdentifierTypeStateIssuer
24344OtherFLFLORIDA BLUE
000892200MedicaidFL

National Provider Directory

National Provider Directory

Locations

13001 State Road 80
#8
Loxahatchee, FL 33470

1397 Medical Park Blvd
Ste 180
Wellington, FL 33414
Phone (561) 753-2680

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654041600000",
    "number": "1902930795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6415 LAKE WORTH RD STE 102",
            "city": "GREENACRES",
            "state": "FL",
            "postal_code": "334633009",
            "telephone_number": "561-331-0808",
            "fax_number": "561-237-6034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 JFK DR STE 120",
            "city": "ATLANTIS",
            "state": "FL",
            "postal_code": "334626623",
            "telephone_number": "561-331-0808",
            "fax_number": "561-594-0880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALM BEACH SURGICAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-15",
        "last_updated": "2022-06-01",
        "certification_date": "2022-06-01",
        "status": "A",
        "authorized_official_last_name": "IBARROLA",
        "authorized_official_first_name": "AGUSTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "561-331-0808",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA BLUE",
            "identifier": "24344",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000892200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlantis, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2022; 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.