NPIMap

Organization Active NPI

Mdlive Medical Group Il LLC

  • Psychiatry Physician
  • Miramar, FL
National Provider Identifier
1164139366
Registry record updated Oct 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
MDLIVE MEDICAL GROUP IL LLC
Practice address
3350 SW 148TH Ave Ste 300
Miramar, FL 33027-3259
Phone
(800) 400-6354
NPI assigned
Oct 28, 2022
Organization subpart
Yes
Parent organization
MDLIVE MEDICAL GROUP IL LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 28, 2022

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

Authorized official

Name
Merry Schumacher
Title
Sr. Director Provider Services
Phone
(800) 400-6354

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X
Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 104100000X
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

3350 SW 148TH Ave Ste 300
Miramar, FL 33027-3259

Mailing address

3350 SW 148TH Ave Ste 300
Miramar, FL 33027-3259
Phone (800) 400-6354

National Provider Directory

National Provider Directory
Tax ID family
Mdlive Medical Group Il LLC4 organizations share this tax ID, including this one
Part of
Mdlive Medical Group Il LLC

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1666915200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666915200000",
    "number": "1164139366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3350 SW 148TH AVE STE 300",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330273259",
            "telephone_number": "800-400-6354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3350 SW 148TH AVE STE 300",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330273259",
            "telephone_number": "800-400-6354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MDLIVE MEDICAL GROUP IL LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MDLIVE MEDICAL GROUP IL LLC",
        "enumeration_date": "2022-10-28",
        "last_updated": "2022-10-28",
        "certification_date": "2022-10-28",
        "status": "A",
        "authorized_official_last_name": "SCHUMACHER",
        "authorized_official_first_name": "MERRY",
        "authorized_official_title_or_position": "SR. DIRECTOR PROVIDER SERVICES",
        "authorized_official_telephone_number": "800-400-6354"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Miramar, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2022; 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.