Individual provider Active NPI

Nikki Joseph

  • Family Medicine Physician
  • Sunrise, FL
National Provider Identifier
1174057137
Registry record updated Sep 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS16740 Issued in FL
Practice address
12651 W Sunrise Blvd Ste 202
Sunrise, FL 33323-0906
Phone
(954) 838-8801
Fax
(954) 838-8807
NPI assigned
Apr 17, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 30, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X OS16740 FL Primary

Addresses

Primary practice location

12651 W Sunrise Blvd Ste 202
Sunrise, FL 33323-0906

Mailing address

12651 W Sunrise Blvd Ste 202
Sunrise, FL 33323-0906
Phone (954) 838-8801

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
I20200904001434 FL Practitioner - Family Practice 5890030001 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
East Florida Primary Care LLCGroup PAC ID 7315091899, 4 clinicians

Practice addresses (Care Compare)

12651 W Sunrise Blvd
202 Westside Primary Care at Sunrise
Sunrise, FL 33323-0906
Phone (954) 838-8801

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
East Florida Primary Care LLC Family Medicine CurrentSince Oct 1, 2020 Accepting new patients
Palm Beach General Surgery LLC PastSince Oct 4, 2020 Accepting new patients

Locations

8251 W Broward Blvd
Ste 300
Plantation, FL 33324
Phone (954) 475-9535

8395 W Oakland Park Blvd
Ste E
Sunrise, FL 33351
Phone (954) 472-1322

12651 W Sunrise Blvd
Sunrise, FL 33323
Phone (954) 356-2721

12651 W Sunrise Blvd
Ste 202
Sunrise, FL 33323
Phone (954) 838-7200

2000 Health Park Dr
Brentwood, TN 37027
Phone (615) 372-5426

Interoperability endpoints

  • Direct secure messaging: nikki.joseph@hca4.eclinicaldirectplus.com

Organizations & group practices 2

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": "1492387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601424000000",
    "number": "1174057137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12651 W SUNRISE BLVD STE 202",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333230906",
            "telephone_number": "954-838-8801",
            "fax_number": "954-838-8807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12651 W SUNRISE BLVD STE 202",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333230906",
            "telephone_number": "954-838-8801",
            "fax_number": "954-838-8807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOSEPH",
        "first_name": "NIKKI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-04-17",
        "last_updated": "2020-09-30",
        "certification_date": "2020-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS16740",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sunrise, FL

Sources for this page

Verify at the official NPI Registry.