Organization Active NPI

Spine and Brain Surgery, LLC

  • Neurological Surgery Physician
  • Delray Beach, FL
National Provider Identifier
1992055131
Registry record updated Oct 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
ME98749 Issued in FL
Legal business name
SPINE AND BRAIN SURGERY, LLC
Practice address
5341 W Atlantic Ave Ste 302
Delray Beach, FL 33484
Phone
(561) 403-5175
NPI assigned
Sep 14, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2024

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

Authorized official

Name
Mrs. Mary Newell
Title
Administration
Phone
(561) 403-5175

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207T00000X ME98749 FL Primary

Addresses

Primary practice location

5341 W Atlantic Ave Ste 302
Delray Beach, FL 33484

Mailing address

5341 W Atlantic Ave Ste 302
Delray Beach, FL 33484-8166
Phone (561) 403-5175

Other practice location 1

911 E Oakland Park Blvd
Oakland Park, FL 33334-2725
Phone (561) 403-5175

Other practice location 2

1411 N Flagler Dr Ste 6400
West Palm Beach, FL 33401-3425
Phone (561) 403-5175

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130409000607 FL Part B Supplier - Clinic/Group Practice 1153567599 Practice locations: Delray Beach, FL

National Provider Directory

National Provider Directory

Locations

220 Congress Park Dr
Ste 300
Delray Beach, FL 33445
Phone (561) 403-5175

NPI Registry JSON

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

{
    "created_epoch": "1347580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729641600000",
    "number": "1992055131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5341 W ATLANTIC AVE STE 302",
            "city": "DELRAY BEACH",
            "state": "FL",
            "postal_code": "334848166",
            "telephone_number": "561-403-5175",
            "fax_number": "866-313-8923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5341 W ATLANTIC AVE STE 302",
            "city": "DELRAY BEACH",
            "state": "FL",
            "postal_code": "33484",
            "telephone_number": "561-403-5175"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "911 E Oakland Park Blvd",
            "address_purpose": "LOCATION",
            "city": "Oakland Park",
            "state": "FL",
            "postal_code": "333342725",
            "country_code": "US",
            "telephone_number": "561-403-5175",
            "fax_number": "866-313-8923",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1411 N Flagler Dr Ste 6400",
            "address_purpose": "LOCATION",
            "city": "West Palm Beach",
            "state": "FL",
            "postal_code": "334013425",
            "country_code": "US",
            "telephone_number": "561-403-5175",
            "fax_number": "866-313-8923",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SPINE AND BRAIN SURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-14",
        "last_updated": "2024-10-23",
        "certification_date": "2024-10-23",
        "status": "A",
        "authorized_official_last_name": "NEWELL",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "ADMINISTRATION",
        "authorized_official_telephone_number": "561-403-5175",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neurological Surgery",
            "state": "FL",
            "license": "ME98749",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Delray Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2024; 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.