Individual provider Active NPI

John Edward Stephens Jr., M.D.

  • Pediatric Gastroenterology Physician
  • Wellington, FL
National Provider Identifier
1093780132
Registry record updated Dec 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
License
ME 92461 Issued in FL
Practice address
3377 S State Road 7 Ste 100
Wellington, FL 33449-8002
Phone
(561) 341-7000
Fax
(561) 341-7055
NPI assigned
Feb 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Gastroenterology Physician 2080P0206X ME 92461 FL Primary

Addresses

Primary practice location

3377 S State Road 7 Ste 100
Wellington, FL 33449-8002

Mailing address

2900 Corporate Way
Door D
Miramar, FL 33025-3925
Phone (954) 276-5603

Other identifiers 1

IdentifierTypeStateIssuer
272288700MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060125000217 FL Practitioner - Pediatric MedicinePractitioner - Gastroenterology 5092739300 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME 92461FLMDPediatric Gastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
South Broward Hospital District CurrentSince Sep 1, 2024 Accepting new patients
South Broward Hospital District Pediatric Gastroenterology CurrentSince Sep 1, 2024 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
South Broward Hospital District Past Accepting new patients
Adams & Stephens, PA Pediatric Gastroenterology PastSince Aug 2, 2020 Accepting new patients
South Broward Hospital District Past Accepting new patients

Locations

1131 N 35th Ave
Ste 300
Hollywood, FL 33021
Phone (954) 265-1616

2900 Corporate Way
#D
Miramar, FL 33025
Phone (954) 276-5581

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734912000000",
    "number": "1093780132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 CORPORATE WAY",
            "address_2": "DOOR D",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330253925",
            "telephone_number": "954-276-5603",
            "fax_number": "954-985-7074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3377 S STATE ROAD 7 STE 100",
            "city": "WELLINGTON",
            "state": "FL",
            "postal_code": "334498002",
            "telephone_number": "561-341-7000",
            "fax_number": "561-341-7055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEPHENS",
        "first_name": "JOHN",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-22",
        "last_updated": "2024-12-23",
        "certification_date": "2024-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "FL",
            "license": "ME 92461",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "272288700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wellington, FL

Sources for this page

Verify at the official NPI Registry.