Lourdes Portales Dale, PHD

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

10538 Issued in FL

Practice address

580 W 8TH St FL Towerii6
Jacksonville, FL 32209-6533

Phone

(860) 305-2908

NPI assigned

Jun 18, 2020

Last updated

Jun 18, 2020By the provider in NPPES

Sex

Female

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: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

59.59 of 100Reported as apm

Quality

59.93

Promoting interoperability

0

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• University of Florida Jacksonville Physicians, Inc.

  • Internal Medicine Physician
  • Jacksonville, FL
  • NPI 1144276452
  Medicare reassignment NPD
• University of Florida Jacksonville Physicians Inc

  • Psychiatry Physician
  • Jacksonville, FL
  • NPI 1558521823
  NPD
• University of Florida Jacksonville Physicians, Inc.

  dba UF Health Imaging Center-Baymeadows

  • Physiological Laboratory
  • Jacksonville, FL
  • NPI 1831800952
  NPD

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

{
    "created_epoch": "1592438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592438400000",
    "number": "1952927600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830-13 A1A NORTH",
            "address_2": "#690",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "32082",
            "telephone_number": "860-305-2908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "580 W 8TH ST FL TOWERII6",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322096533",
            "telephone_number": "860-305-2908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DALE",
        "first_name": "LOURDES",
        "middle_name": "PORTALES",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-18",
        "last_updated": "2020-06-18",
        "certification_date": "2020-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CT",
            "license": "002436",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "FL",
            "license": "10538",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lorraine H Dajani, M.D.
• Victoria Virginia Dajani, PA
• Lara Toufic Dakhoul, M.D.
• Ali Dakroub, MD
• Ashley Nicole Dale
• Stacy Dale
• T'Erra Dale
• Allyson Lynne Daley, APRN, FNP
• Cephas Daley, ARNP
• John Daley

• Clinical Child & Adolescent Psychologist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Clinical Child & Adolescent Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2020; 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.
• 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.