BRAIN AND SPINE INSTITUTE OF PORT ORANGE, LLC
NPI 1699016949
Psychiatry & Neurology - Neurology in Port Orange, FL
NPI Status: Active since March 12, 2013
Contact Information
1211 DUNLAWTON AVE
PORT ORANGE, FL
ZIP 32127
Phone: (386) 304-0111
- Organization
- Psychiatry & Neurology
- Neurology
- CLIA Number: 10D2114491
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 06-14-2026
About BRAIN AND SPINE INSTITUTE OF PORT ORANGE, LLC
This page provides the complete NPI Profile along with additional information for Brain And Spine Institute Of Port Orange, Llc, a provider established in Port Orange, Florida operating as a Psychiatry & Neurology, focusing in neurology . The healthcare provider is registered in the NPI registry with number 1699016949 assigned on March 2013. The practitioner's primary taxonomy code is 2084N0400X with license number ME80334 (FL). The provider is registered as an organization and their NPI record was last updated 12 years ago. The organization operates as a single speciality business group with one or more individual providers who practice the same area of specialization. The authorized official of this NPI record is Dr. Timothy Joseph Wierzbicki M.d. (Ceo)
- NPI
- 1699016949
- Provider Name
- BRAIN AND SPINE INSTITUTE OF PORT ORANGE, LLC
- Entity Type
- Organization
- Location Address
- 1211 DUNLAWTON AVE PORT ORANGE, FL 32127
- Location Phone
- (386) 304-0111
- Mailing Address
- 1211 DUNLAWTON AVE PORT ORANGE, FL 32127
- Mailing Phone
- (386) 304-0111
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 03-12-2013
- Last Update Date
- 03-15-2013
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Psychiatry & Neurology Neurology
- Taxonomy Code
- 2084N0400X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- ME80334
- License State
- FL
- Taxonomy Description
- A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures.
Group Taxonomy 193400000X SINGLE SPECIALTY GROUP
This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 35363X | MEDICARE PIN (08) | FL | |
| 130022355 | OTHER (01) | FL | MEDICARE RAILROAD |
| 259058100 | MEDICAID (05) | FL | |
| H16730 | MEDICARE UPIN (02) | FL |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 10D2114491
- Facility Type
- Physician Office
- Certificate Effective Date
- June 15, 2024
- Certificate Expiration Date
- June 14, 2026
- Laboratory Director
- TIMOTHY J. WIERZBICKI
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Brain And Spine Institute Of Port Orange, Llc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 6 | 9 | 9 | 0 | 1 | 6 | 9 | 4 | 9 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 6 | 18 | 9 | 0 | 1 | 12 | 9 | 8 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 6 + 1 + 8 + 9 + 0 + 1 + 1 + 2 + 9 + 8 + 24 = 71 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 80 - 71 = 9 | 9 | ||||||||
The NPI number 1699016949 is valid because the calculated check digit 9 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 2 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1528385176 | MS. GRACE PEDERSEN ARNP Individual | Nurse Practitioner (Family) | 1211 DUNLAWTON AVE PORT ORANGE, FL 32127 (386) 675-4411 |
| 1134145741 | DR. TIMOTHY J WIERZBICKI MD Individual | Psychiatry & Neurology (Neurology) | 1211 DUNLAWTON AVE PORT ORANGE, FL 32127 (386) 304-0111 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1699016949, enumerated in the NPI registry as an "organization" on March 12, 2013
The provider is located at 1211 Dunlawton Ave Port Orange, Fl 32127 and the phone number is (386) 304-0111
This medical organization specializes in Psychiatry & Neurology with taxonomy code 2084N0400X with a focus in Neurology
The provider might be accepting Accepts: Medicare, Medicaid and Railroad Medicare. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
The provider's CLIA number is 10D2114491 for a "physician office" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria..
This NPI record was last updated on March 12, 2013. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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