Individual provider Active NPI

Elvire Jacques, M.D.

  • Maternal & Fetal Medicine Physician
  • Hollywood, FL
National Provider Identifier
1104840719
Registry record updated Nov 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Maternal & Fetal Medicine PhysicianTaxonomy code 207VM0101X
License
ME84551 Issued in FL
Practice address
4105 Pembroke Rd
Hollywood, FL 33021-8103
Phone
(954) 265-3015
NPI assigned
Jul 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X ME84551 FL
Maternal & Fetal Medicine Physician 207VM0101X ME84551 FL Primary

Addresses

Primary practice location

4105 Pembroke Rd
Hollywood, FL 33021-8103

Mailing address

2900 Corporate Way
Door D
Miramar, FL 33025-3925
Phone (954) 276-5685

Other identifiers 1

IdentifierTypeStateIssuer
111183200MedicaidFL

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
I20050822000417 FL Practitioner - Obstetrics/Gynecology 5890725659 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
South Broward Hospital DistrictGroup PAC ID 8123927373, 659 clinicians

Practice addresses (Care Compare)

20801 Biscayne Blvd
Suite 200
Aventura, FL 33180-1422
Phone (954) 265-3015

4105 Pembroke Rd
Hollywood, FL 33021-8103
Phone (954) 265-3015

601 N Flamingo Rd
Suite 408
Pembroke Pines, FL 33028-1012
Phone (954) 265-3015

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME84551FLMDMaternal & Fetal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
South Broward Hospital District CurrentSince Oct 1, 2022 Accepting new patients
South Broward Hospital District Maternal & Fetal Medicine CurrentSince Oct 1, 2022 Accepting new patients
Southeast Perinatal Associates, Inc. Obstetrics & Gynecology Current Accepting new patients
South Broward Hospital District Past Accepting new patients

Locations

20801 Biscayne Blvd
Ste 200
Aventura, FL 33180
Phone (954) 265-3015

1150 N 35th Ave
Ste 550
Hollywood, FL 33021
Phone (209) 946-7200

4105 Pembroke Rd
Hollywood, FL 33021
Phone (954) 985-1551

1901 SW 172nd Ave
Miramar, FL 33029
Phone (954) 276-5401

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

3501 Johnson St
Pembroke Park, FL 33021
Phone (954) 265-2000

703 N Flamingo Rd
Pembroke Pnes, FL 33028
Phone (954) 436-5000

601 N Flamingo Rd
Ste 408
Pembroke Pnes, FL 33028
Phone (954) 265-3015

Organizations & group practices 4

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": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667433600000",
    "number": "1104840719",
    "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": "954-276-5685",
            "fax_number": "954-985-7074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4105 PEMBROKE RD",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330218103",
            "telephone_number": "954-265-3015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACQUES",
        "first_name": "ELVIRE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-27",
        "last_updated": "2022-11-03",
        "certification_date": "2022-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "FL",
            "license": "ME84551",
            "primary": false
        },
        {
            "code": "207VM0101X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Maternal & Fetal Medicine",
            "state": "FL",
            "license": "ME84551",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111183200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hollywood, FL

Sources for this page

Verify at the official NPI Registry.