Individual provider Active NPI

Jose David Sandoval-Sus, M.D.

  • Hematology & Oncology Physician
  • Pembroke Pines, FL
National Provider Identifier
1174846158
Registry record updated Apr 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
ME116179 Issued in FL
Practice address
603 N Flamingo Rd Ste 151
Pembroke Pines, FL 33028-1021
Phone
(954) 265-4325
Fax
(954) 443-4615
NPI assigned
Mar 5, 2010
Last updated
Apr 5, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME116179 FL
Hematology (Internal Medicine) Physician 207RH0000X ME116179 FL
Hematology & Oncology Physician 207RH0003X ME116179 FL Primary

Addresses

Primary practice location

603 N Flamingo Rd Ste 151
Pembroke Pines, FL 33028-1021

Mailing address

2900 Corporate Way
Door D
Miramar, FL 33025-3925
Phone (954) 276-5685

Other practice location 1

20801 Biscayne Blvd Ste 200
Aventura, FL 33180-1422
Phone (954) 265-4325

Other practice location 2

801 N Flamingo Rd Ste 11
Pembroke Pines, FL 33028-1019
Phone (954) 265-4325

Other identifiers 1

IdentifierTypeStateIssuer
021103800MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jsandovalsus169282@MHSDIRECT.NET Direct

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
I20170726000775 FL Practitioner - Hematology/Oncology 1052681947 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hematology/Oncology
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
South Broward Hospital DistrictGroup PAC ID 8123927373, 659 clinicians

Practice addresses (Care Compare)

801 N Flamingo Rd
Suite 11
Pembroke Pines, FL 33028-1019
Phone (954) 844-6868

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME116179FLMDHematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
South Broward Hospital District CurrentSince Jun 26, 2017 Accepting new patients
South Broward Hospital District Current Accepting new patients
South Broward Hospital District Hematology CurrentSince Jun 26, 2017 Accepting new patients
South Broward Hospital District Past Accepting new patients

Locations

20801 Biscayne Blvd
Ste 200
Aventura, FL 33180
Phone (954) 265-3015

20950 NE 27th Ct
Ste 203
Aventura, FL 33180
Phone (305) 933-6545

1750 E Hallandale Beach Blvd
Hallandale Beach, FL 33009
Phone (954) 276-9700

1150 N 35th Ave
Ste 170
Hollywood, FL 33021
Phone (954) 985-1500

2900 Corporate Way
#D
Miramar, FL 33025
Phone (954) 276-5581

12235 Pines Blvd
Pembroke Pines, FL 33026
Phone (954) 265-1125

603 N Flamingo Rd
Ste 151
Pembroke Pines, FL 33028
Phone (954) 265-2750

801 N Flamingo Rd
Ste 11
Pembroke Pines, FL 33028

Interoperability endpoints

  • Direct secure messaging: jsandovalsus169282@mhsdirect.net

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1267747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617580800000",
    "number": "1174846158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 CORPORATE WAY",
            "address_2": "DOOR D",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330253925",
            "telephone_number": "954-276-5685",
            "fax_number": "954-985-7074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 N FLAMINGO RD STE 151",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330281021",
            "telephone_number": "954-265-4325",
            "fax_number": "954-443-4615"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20801 Biscayne Blvd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Aventura",
            "state": "FL",
            "postal_code": "331801422",
            "country_code": "US",
            "telephone_number": "954-265-4325",
            "fax_number": "305-935-3186",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "801 N Flamingo Rd Ste 11",
            "address_purpose": "LOCATION",
            "city": "Pembroke Pines",
            "state": "FL",
            "postal_code": "330281019",
            "country_code": "US",
            "telephone_number": "954-265-4325",
            "fax_number": "954-443-4747",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANDOVAL-SUS",
        "first_name": "JOSE",
        "middle_name": "DAVID",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-03-05",
        "last_updated": "2021-04-05",
        "certification_date": "2021-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME116179",
            "primary": false
        },
        {
            "code": "207RH0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology",
            "state": "FL",
            "license": "ME116179",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "FL",
            "license": "ME116179",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "021103800",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jsandovalsus169282@MHSDIRECT.NET",
            "affiliation": "N",
            "endpointDescription": "MHS DSM",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "20801 Biscayne Blvd Ste 200",
            "city": "Aventura",
            "state": "FL",
            "country_code": "US",
            "postal_code": "331801422",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Pembroke Pines, FL

Sources for this page

Verify at the official NPI Registry.