Jerome Vitale, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN13975 Issued in FL

Practice address

1343 SE Port St Lucie Blvd
Port Lucie, FL 34952

Phone

(772) 337-1111

Fax

(772) 337-6352

NPI assigned

Apr 11, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Boulevard Center for Advanced Dentistry

  • Dental Clinic/Center
  • Port St Lucie, FL
  • NPI 1275906232
  NPD (past) Authorized official
• Boulevard Dental Associates

  • Dentist
  • Port Saint Lucie, FL
  • NPI 1508116781
  NPD (past)
• N&V Dental LLC

  • Dentist
  • Delray Beach, FL
  • NPI 1255920435

  General Practice

  NPD (past)
• Robert a. Adami, DDS, PA

  dba Designer Dental

  • General Practice Dentistry
  • Delray Beach, FL
  • NPI 1619162914
  NPD (past)

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

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725580800000",
    "number": "1942423280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1343 SE PORT ST LUCIE BLVD",
            "city": "PORT LUCIE",
            "state": "FL",
            "postal_code": "34952",
            "telephone_number": "772-337-1111",
            "fax_number": "772-337-6352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1343 SE PORT ST LUCIE BLVD",
            "city": "PORT LUCIE",
            "state": "FL",
            "postal_code": "34952",
            "telephone_number": "772-337-1111",
            "fax_number": "772-337-6352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VITALE",
        "first_name": "JEROME",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-11",
        "last_updated": "2024-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN13975",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "043398",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.