Individual provider Active NPI

Jorge Hernandez, DPM

  • Foot & Ankle Surgery Podiatrist
  • Weston, FL
National Provider Identifier
1104069079
Registry record updated Jun 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
PO3424 Issued in FL
Practice address
2701 Executive Park Dr Ste 3
Weston, FL 33331-3632
Phone
(954) 328-9770
Fax
(954) 212-9817
NPI assigned
Apr 8, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X PO3424 FL Primary

Addresses

Primary practice location

2701 Executive Park Dr Ste 3
Weston, FL 33331-3632

Mailing address

13315 SW 26TH St
Miramar, FL 33027-3875
Phone (954) 328-9770

Other practice location 1

3410 W 84th St Ste 100
Hialeah, FL 33018-4906
Phone (305) 667-5683

Other identifiers 1

IdentifierTypeStateIssuer
PO3424OtherFLFLORIDA LICENCE

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121023000826 FL Practitioner - Podiatry 7315197555 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Kent State University College of Podiatric Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2701 Executive Park Dr
Suite 3
Weston, FL 33331-3632
Phone (954) 328-9770

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue63
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PO3424FLMDFoot & Ankle Surgery Podiatrist

Organizations & group practices 2

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": "1239148800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750723200000",
    "number": "1104069079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13315 SW 26TH ST",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330273875",
            "telephone_number": "954-328-9770",
            "fax_number": "954-212-9817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2701 EXECUTIVE PARK DR STE 3",
            "city": "WESTON",
            "state": "FL",
            "postal_code": "333313632",
            "telephone_number": "954-328-9770",
            "fax_number": "954-212-9817"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3410 W 84th St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Hialeah",
            "state": "FL",
            "postal_code": "330184906",
            "country_code": "US",
            "telephone_number": "305-667-5683",
            "fax_number": "305-826-7774",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HERNANDEZ",
        "first_name": "JORGE",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-08",
        "last_updated": "2025-06-24",
        "certification_date": "2025-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "FL",
            "license": "PO3424",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA LICENCE",
            "identifier": "PO3424",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Weston, FL

Sources for this page

Verify at the official NPI Registry.