Premiermd Ipa, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

PREMIERMD IPA, LLC

Practice address

3465 Galt Ocean Drive
203
Fort Lauderdale, FL 33308-7003

Phone

(954) 561-5135

Fax

(954) 561-5180

NPI assigned

Jul 18, 2014

Organization subpart

No

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

Authorized official

Name

David Fater, COO

Title

Chief Operating Officer

Phone

(954) 561-5135

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1405641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405641600000",
    "number": "1134536451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3465 GALT OCEAN DRIVE",
            "address_2": "203",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333087003",
            "telephone_number": "954-561-5135",
            "fax_number": "954-561-5180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3465 GALT OCEAN DRIVE",
            "address_2": "203",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333087003",
            "telephone_number": "954-561-5135",
            "fax_number": "954-561-5180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIERMD IPA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-18",
        "last_updated": "2014-07-18",
        "status": "A",
        "authorized_official_last_name": "FATER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "954-561-5135",
        "authorized_official_credential": "COO"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.