Organization Active NPI

South Florida Hair Restoration

  • Primary Care Clinic/Center
  • Tamarac, FL
National Provider Identifier
1114644002
Registry record updated Jun 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
SOUTH FLORIDA HAIR RESTORATION
Practice address
7710 NW 71St CT Ste 303
Tamarac, FL 33321-2932
Phone
(954) 960-5763
Fax
(954) 586-4178
NPI assigned
Oct 21, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2024

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

Authorized official

Name
Dr. Real Martin, MDNPI 1538143094
Title
Medical Director/Owner
Phone
(954) 592-5718

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

7710 NW 71St CT Ste 303
Tamarac, FL 33321-2932

Mailing address

7710 NW 71St CT Ste 303
Tamarac, FL 33321-2932
Phone (954) 960-5763

Other names 1

  • Dr. Martin's Wellness Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230906001206 FL Part B Supplier - Clinic/Group Practice 9335502517 Receives reassigned benefits from 1 practitioner
Practice locations: Tamarac, FL

National Provider Directory

National Provider Directory

Locations

7710 NW 71st Ct
Ste 303
Tamarac, FL 33321
Phone (954) 726-6868

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1666310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718236800000",
    "number": "1114644002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7710 NW 71ST CT STE 303",
            "city": "TAMARAC",
            "state": "FL",
            "postal_code": "333212932",
            "telephone_number": "954-960-5763",
            "fax_number": "954-586-4178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7710 NW 71ST CT STE 303",
            "city": "TAMARAC",
            "state": "FL",
            "postal_code": "333212932",
            "telephone_number": "954-960-5763",
            "fax_number": "954-586-4178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH FLORIDA HAIR RESTORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-21",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "REAL",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR/OWNER",
        "authorized_official_telephone_number": "954-592-5718",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Martin's Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tamarac, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.