Innervate Neurology Clinic, Inc.

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

ME122880 Issued in FL

Legal business name

INNERVATE NEUROLOGY CLINIC, INC.

Doing business as

Innervate Muscle and Nerve Specialist

Practice address

14810 Old Saint Augustine Rd
Suite 207B
Jacksonville, FL 32258-2451

Phone

(904) 298-2525

Fax

(904) 677-7873

NPI assigned

Aug 14, 2015

Organization subpart

No

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

Authorized official

Name

Mr. Aurelio A Muzaurieta Jr.

Title

President

Phone

(904) 631-2669

Specialties & licenses 3

Addresses

Other names 1

• Innervate Muscle and Nerve Specialist Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 3

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.

• Amudha Mani Perumal, M.D

  • Neurology Physician
  • St Augustine, FL
  • NPI 1629003579
  Medicare reassignment
• Travis Randall Von Tobel, M.D.

  • Interventional Pain Medicine Physician
  • Jacksonville, FL
  • NPI 1487954723
  Medicare reassignment
• Krishna Rao Nalluri, M.D.

  • Sleep Medicine (Psychiatry & Neurology) Physician
  • Gulfport, MS
  • NPI 1336212554

  FL

  Medicare reassignment

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

{
    "created_epoch": "1439510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439510400000",
    "number": "1972979888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1450",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320671450",
            "telephone_number": "904-298-2525",
            "fax_number": "904-677-7873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14810 OLD SAINT AUGUSTINE RD",
            "address_2": "SUITE 207B",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322582451",
            "telephone_number": "904-298-2525",
            "fax_number": "904-677-7873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNERVATE NEUROLOGY CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-14",
        "last_updated": "2015-08-14",
        "status": "A",
        "authorized_official_last_name": "MUZAURIETA",
        "authorized_official_first_name": "AURELIO",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-631-2669",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "2081N0008X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Neuromuscular Medicine",
            "state": "FL",
            "license": "ME122880",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "FL",
            "license": "ME122880",
            "primary": true
        },
        {
            "code": "2084N0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": "FL",
            "license": "ME122880",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Innervate Muscle and Nerve Specialist",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Neurology Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Neurology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.