Icon Medical Centers, LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

ICON MEDICAL CENTERS, LLC

Practice address

3625 Hollywood Blvd
Hollywood, FL 33021-6854

Phone

(954) 987-8400

Fax

(352) 694-6338

NPI assigned

Mar 5, 2021

Last updated

Mar 5, 2021By the provider in NPPES

Organization subpart

Yes

Parent organization

ICON MEDICAL CENTERS, LLCAs reported in NPPES

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

Authorized official

Name

Edward J Lucas, MDNPI 1659301109

Title

Manager

Phone

(352) 694-6331

Specialties & licenses 1

Addresses

Electronic endpoints 1

Part of

Icon Medical Center LLC

Locations

Interoperability endpoints

• Direct secure messaging: credentialing@iconmedicalcenters.com

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Icon Medical Centers, LLC

  • Physical Medicine & Rehabilitation Physician
  • Miami, FL
  • NPI 1497062012
  NPPES parent name

Practitioners 1

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.

• Edward J Lucas Jr., MD

  • Emergency Medicine Physician
  • Ocala, FL
  • NPI 1659301109
  Authorized official Same address or phone

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

{
    "created_epoch": "1614902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614902400000",
    "number": "1073108692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "232 SW 8TH ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331303514",
            "telephone_number": "305-858-8845",
            "fax_number": "352-694-6338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3625 HOLLYWOOD BLVD",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330216854",
            "telephone_number": "954-987-8400",
            "fax_number": "352-694-6338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICON MEDICAL CENTERS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ICON MEDICAL CENTERS, LLC",
        "enumeration_date": "2021-03-05",
        "last_updated": "2021-03-05",
        "certification_date": "2021-02-05",
        "status": "A",
        "authorized_official_last_name": "LUCAS",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "352-694-6331",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "CREDENTIALING@ICONMEDICALCENTERS.COM",
            "affiliation": "N",
            "endpointDescription": "EMAIL",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "EMAIL",
            "address_1": "3625 Hollywood Blvd",
            "city": "Hollywood",
            "state": "FL",
            "country_code": "US",
            "postal_code": "330216854",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Chiropractor in Hollywood, FL
• Providers in Hollywood, FL by specialty
• Chiropractor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.