NPIMap

Organization Active NPI

Jerome R Obed D.O.,P.a.

Doing business as Broward Dermatology and Cosmetic Specialists

  • Dermatology Physician
  • Fort Lauderdale, FL
National Provider Identifier
1063760502
Registry record updated May 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
JEROME R OBED D.O.,P.A.
Doing business as
Broward Dermatology and Cosmetic Specialists
Practice address
500 SE 15TH St
Suite 108
Ft Lauderdale, FL 33316-1952
Phone
(954) 990-6591
NPI assigned
Aug 15, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2014

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

Authorized official

Name
Dr. Jerome R Obed, D.O.NPI 1720055585
Title
President
Phone
(954) 990-6591

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X Primary
MOHS-Micrographic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0101X
Procedural Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207NS0135X

Addresses

Primary practice location

500 SE 15TH St
Suite 108
Ft Lauderdale, FL 33316-1952

Mailing address

500 SE 15TH St
Suite 108
Ft Lauderdale, FL 33316-1952
Phone (954) 990-6591

Other names 1

  • Broward Dermatology and Cosmetic Specialists Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130403000477 FL Part B Supplier - Clinic/Group Practice 9436394962 Receives reassigned benefits from 2 practitioners
Practice locations: Ft Lauderdale, FL

National Provider Directory

National Provider Directory
Tax ID family
Broward Dermatology2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1344988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1399939200000",
    "number": "1063760502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 SE 15TH ST",
            "address_2": "SUITE 108",
            "city": "FT LAUDERDALE",
            "state": "FL",
            "postal_code": "333161952",
            "telephone_number": "954-990-6591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 SE 15TH ST",
            "address_2": "SUITE 108",
            "city": "FT LAUDERDALE",
            "state": "FL",
            "postal_code": "333161952",
            "telephone_number": "954-990-6591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEROME R OBED D.O.,P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-15",
        "last_updated": "2014-05-13",
        "status": "A",
        "authorized_official_last_name": "OBED",
        "authorized_official_first_name": "JEROME",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "954-990-6591",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Broward Dermatology and Cosmetic Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Lauderdale, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2014; 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.