Healthy Senior Medical Group LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

HEALTHY SENIOR MEDICAL GROUP LLC

Practice address

515 E Las Olas Blvd Ste 120
Fort Lauderdale, FL 33301-4261

Phone

(954) 787-8874

Fax

(954) 787-8875

NPI assigned

Nov 12, 2020

Organization subpart

No

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

Authorized official

Name

Christopher J Pettas

Title

Ceo

Phone

(561) 702-1299

Specialties & licenses 1

Addresses

Electronic endpoints 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Hatice Hasman Fugate, APRN

  • Primary Care Nurse Practitioner
  • Miami, FL
  • NPI 1235776584
  NPD (past)
• Yolette Romelus, ARNP

  • Family Nurse Practitioner
  • Riviera Beach, FL
  • NPI 1215447347
  NPD (past)

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

{
    "created_epoch": "1605139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605139200000",
    "number": "1194327379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2199 NE 5TH AVE",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334317610",
            "telephone_number": "561-702-1299",
            "fax_number": "561-584-7505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 E LAS OLAS BLVD STE 120",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333014261",
            "telephone_number": "954-787-8874",
            "fax_number": "954-787-8875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHY SENIOR MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-12",
        "last_updated": "2020-11-12",
        "certification_date": "2020-11-12",
        "status": "A",
        "authorized_official_last_name": "PETTAS",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "561-702-1299"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "cvs",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "515 E Las Olas Blvd Ste 120",
            "city": "Fort Lauderdale",
            "state": "FL",
            "country_code": "US",
            "postal_code": "333014261",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Healthe Home Delivered Meals Inc
• Healtheast Medical Group, Inc.
• Healthtree, LLC
• Healthy Families Broward
• Healthy Families Broward
• Healthy Seniors Medical Holdings LLC
• Healthy Seniors, LLC
• Healthy Solutionz, LLC
• Healthy Works Medical Equipment, LLC
• Healthy You LLC.

• General Practice Physician in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2020; 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.