Individual provider Active NPI

Lydia Beaulieu-Dodd

  • Family Nurse Practitioner
  • Boca Raton, FL
National Provider Identifier
1104235498
Registry record updated Dec 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
ARNP2863042 Issued in FL
Practice address
951 NW 13TH St Ste 1C
Boca Raton, FL 33486-2337
Phone
(561) 361-0065
Fax
(561) 347-1945
NPI assigned
Aug 12, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 7, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X ARNP2863042 FL Primary

Addresses

Primary practice location

951 NW 13TH St Ste 1C
Boca Raton, FL 33486-2337

Mailing address

10381 Lone Star PL
Davie, FL 33328-1345
Phone (954) 303-3839

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150414001159 FL Practitioner - Nurse Practitioner 8022336551 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anthony N Dardano DO PAGroup PAC ID 9638275670, 2 clinicians

Practice addresses (Care Compare)

951 NW 13 St
Boca Raton, FL 33486-2337
Phone (561) 361-0065

Hospital & facility affiliations

  • Activa Home Health Home health agency, Boynton Beach, FL, CCN 109143
  • Delray Medical Center Hospital, Delray Beach, FL, CCN 100258

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Anthony N Dardano D O P a CurrentSince Sep 20, 2014 Accepting new patients

Locations

951 NW 13th St
Ste 1C
Boca Raton, FL 33486
Phone (561) 361-0065

951 NW 13th St
Ste 4D
Boca Raton, FL 33486
Phone (561) 361-0065

Organizations & group practices 1

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1407801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607299200000",
    "number": "1104235498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10381 LONE STAR PL",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333281345",
            "telephone_number": "954-303-3839",
            "fax_number": "561-347-1945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "951 NW 13TH ST STE 1C",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334862337",
            "telephone_number": "561-361-0065",
            "fax_number": "561-347-1945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEAULIEU-DODD",
        "first_name": "LYDIA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-08-12",
        "last_updated": "2020-12-07",
        "certification_date": "2020-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "ARNP2863042",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boca Raton, FL

Sources for this page

Verify at the official NPI Registry.