NPIMap

Organization Active NPI

Brain and Spine LLC

Doing business as Brain and Spine Specialists

  • Neurology Physician
  • Panama City, FL
National Provider Identifier
1942317896
Registry record updated May 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
BRAIN AND SPINE LLC
Doing business as
Brain and Spine Specialists
Practice address
2202 State Ave Ste 201
Panama City, FL 32405-4582
Phone
(850) 785-0029
Fax
(850) 785-7600
NPI assigned
Aug 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2023

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

Authorized official

Name
Kylie M Marlette
Title
Credentialing Specialist
Phone
(850) 215-1593

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X Primary

Addresses

Primary practice location

2202 State Ave Ste 201
Panama City, FL 32405-4582

Mailing address

2202 State Ave Ste 201
Panama City, FL 32405-4582
Phone (850) 785-0029

Other names 1

  • Brain and Spine Specialists Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040609000373 FL Part B Supplier - Clinic/Group Practice 3779566013 Receives reassigned benefits from 13 practitioners
Practice locations: Panama City, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2009645Brain and Spine Center LLC2202 State Ave Ste 201, Panama City, FL 32405Certificate of waiverJul 8, 2026

National Provider Directory

National Provider Directory

Locations

801 E 6th St
Ste 404
Panama City, FL 32401
Phone 8507850029400

2202 State Ave
Ste 101
Panama City, FL 32405
Phone (850) 785-0029

2202 State Ave
Ste 201
Panama City, FL 32405
Phone (850) 769-3261

Interoperability endpoints

  • FHIR API: https://fhir.fhirpoint.open.allscripts.com/fhirroute/open/0000070

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682899200000",
    "number": "1942317896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2202 STATE AVE STE 201",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324054582",
            "telephone_number": "850-785-0029",
            "fax_number": "850-785-7600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2202 STATE AVE STE 201",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324054582",
            "telephone_number": "850-785-0029",
            "fax_number": "850-785-7600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAIN AND SPINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-25",
        "last_updated": "2023-05-01",
        "certification_date": "2023-03-08",
        "status": "A",
        "authorized_official_last_name": "MARLETTE",
        "authorized_official_first_name": "KYLIE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "850-215-1593"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brain and Spine Specialists",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Brain and Spine Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Panama City, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.