Eileen Nikko Super, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

74602 Issued in GA

Practice address

3601 SW 160TH Ave
Suite 250
Miramar, FL 33027-6308

Phone

(877) 866-7123

Fax

(855) 855-2792

NPI assigned

Jun 2, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Florida Post Acute Care Clinicians, LLC

  • Family Medicine Physician
  • Miramar, FL
  • NPI 1811398811
  Medicare reassignment NPD
• Florida Post Acute Care Clinicians, LLC

  • Family Medicine Physician
  • Miramar, FL
  • NPI 1043760473
  NPD

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

{
    "created_epoch": "1370131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472169600000",
    "number": "1124465067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "936 BROAD ST",
            "address_2": "UNIT 303",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309018200",
            "telephone_number": "801-916-1782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 SW 160TH AVE",
            "address_2": "SUITE 250",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330276308",
            "telephone_number": "877-866-7123",
            "fax_number": "855-855-2792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUPER",
        "first_name": "EILEEN",
        "middle_name": "NIKKO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-02",
        "last_updated": "2016-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "GA",
            "license": "74602",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "74602",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEORGIA COMPOSITE MEDICAL BOARD",
            "identifier": "74602",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sunshine Anesthesia & Wellness Medical Group LLC
• Sunshine Chateau Alf, LLC
• Sunshine Community Mental Health Corp
• Sunshine Lab Services LLC
• Sunshine Mobile Imaging Inc.
• Supreme Home Health Care, LLC
• Suremedical Services LLC
• Surgery Specialists of South Broward, Inc
• Surgicare of Miramar LLC
• Yamilia Suros

• Surgery Physician in Miramar, FL
• Providers in Miramar, FL by specialty
• Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.