NPIMap

Organization Active NPI

PA Surgical Inc

  • Surgical Physician Assistant
  • Boca Raton, FL
National Provider Identifier
1942313879
Registry record updated Sep 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
Legal business name
PA SURGICAL INC
Practice address
621 NW 53Rd St Ste 330
Boca Raton, FL 33487-8281
Phone
(561) 440-7612
Fax
(866) 902-8817
NPI assigned
Aug 16, 2006
Last updated
Sep 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2020

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

Authorized official

Name
Nancy T Bourg
Title
Ceo
Phone
(561) 889-1227

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X NU Primary
Nurse Practitioner 363L00000X NU

Addresses

Primary practice location

621 NW 53Rd St Ste 330
Boca Raton, FL 33487-8281

Mailing address

621 NW 53Rd St Ste 330
Boca Raton, FL 33487-8281
Phone (800) 488-0279

Other identifiers 1

IdentifierTypeStateIssuer
X1578OtherFLBCBS PROVIDER NUMBER

National Provider Directory

National Provider Directory

Locations

621 NW 53rd St
Ste 330
Boca Raton, FL 33487
Phone (561) 440-7617

1250 E Hallandale Beach Blvd
Ste 700
Hallandale Beach, FL 33009
Phone (904) 456-3757

5500 Military Trl
Ste 22324
Jupiter, FL 33458
Phone (561) 440-7617

6815 Biscayne Blvd
Ste 105
Miami, FL 33138
Phone (786) 272-5565

Practitioners & affiliated clinicians

Practitioners 33

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.

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600732800000",
    "number": "1942313879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 NW 53RD ST STE 330",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334878281",
            "telephone_number": "800-488-0279",
            "fax_number": "866-902-8817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 NW 53RD ST STE 330",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334878281",
            "telephone_number": "561-440-7612",
            "fax_number": "866-902-8817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PA SURGICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-16",
        "last_updated": "2020-09-22",
        "certification_date": "2020-09-22",
        "status": "A",
        "authorized_official_last_name": "BOURG",
        "authorized_official_first_name": "NANCY",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "561-889-1227"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "X1578",
            "state": "FL"
        }
    ],
    "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 Sep 22, 2020; 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.