NPIMap

Organization Active NPI

PBH Professional Group, P.a.

Doing business as PATH 5Palms Professional Group

  • Addiction Medicine (Preventive Medicine) Physician
  • Ormond Beach, FL
National Provider Identifier
1912670647
Registry record updated Jul 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Preventive Medicine) PhysicianTaxonomy code 2083A0300X
Legal business name
PBH PROFESSIONAL GROUP, P.A.
Doing business as
PATH 5Palms Professional Group
Practice address
1200 W Granada Blvd Ste 1a
Ormond Beach, FL 32174-8157
Phone
(386) 506-8110
Fax
(386) 463-2170
NPI assigned
Jul 28, 2021
Last updated
Jul 28, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2021

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

Authorized official

Name
Flora Sadri-Azarbayejani, D.O.
Title
President and Secretary
Phone
(413) 522-9246

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU
Clinical Psychologist 103TC0700X NU
Registered Nurse 163W00000X NU
Family Medicine Physician 207Q00000X NU
Psychiatry Physician 2084P0800X NU
Addiction Medicine (Preventive Medicine) Physician 2083A0300X NU Primary

Addresses

Primary practice location

1200 W Granada Blvd Ste 1a
Ormond Beach, FL 32174-8157

Mailing address

103 Powell CT Ste 100
Brentwood, TN 37027-5050
Phone (615) 308-7871

Other names 1

  • PATH 5Palms Professional Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Path 5Palms Professional Group5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

NPI Registry JSON

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

{
    "created_epoch": "1627430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627430400000",
    "number": "1912670647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 POWELL CT STE 100",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370275050",
            "telephone_number": "615-308-7871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 W GRANADA BLVD STE 1A",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321748157",
            "telephone_number": "386-506-8110",
            "fax_number": "386-463-2170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PBH PROFESSIONAL GROUP, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-28",
        "last_updated": "2021-07-28",
        "certification_date": "2021-07-28",
        "status": "A",
        "authorized_official_last_name": "SADRI-AZARBAYEJANI",
        "authorized_official_first_name": "FLORA",
        "authorized_official_title_or_position": "PRESIDENT AND SECRETARY",
        "authorized_official_telephone_number": "413-522-9246",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2083A0300X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Addiction Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PATH 5Palms Professional Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ormond Beach, FL

Sources for this page

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

Verify at the official NPI Registry.