NPIMap

Organization Active NPI

Alexander Pushka MD PA

  • Child & Adolescent Psychiatry Physician
  • Hollywood, FL
National Provider Identifier
1205101862
Registry record updated Aug 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
ME88666 Issued in FL
Legal business name
ALEXANDER PUSHKA MD PA
Practice address
7369 Sheridan St Ste 203
Hollywood, FL 33024-2776
Phone
(954) 983-5330
Fax
(954) 983-5086
NPI assigned
Mar 15, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2020

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

Authorized official

Name
Alexander Pushka, MDNPI 1992793384
Title
Owner
Phone
(954) 579-1110

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X ME88666 FL
Child & Adolescent Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0804X ME88666 FL Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X

Addresses

Primary practice location

7369 Sheridan St Ste 203
Hollywood, FL 33024-2776

Mailing address

7369 Sheridan St Ste 203
Hollywood, FL 33024-2776
Phone (954) 983-5330

Other identifiers 1

IdentifierTypeStateIssuer
004704500OtherFLGROUP MEDICAID NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120524000406 FL Part B Supplier - Clinic/Group Practice 1850554163 Receives reassigned benefits from 9 practitioners
Practice locations: Hollywood, FL

National Provider Directory

National Provider Directory

Locations

3911 Hollywood Blvd
Ste 201
Hollywood, FL 33021
Phone (754) 888-1368

300 S Pine Island Rd
Ste 224
Plantation, FL 33324
Phone (754) 801-9750

Networks

  • HealthSun Health Plans Network

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1331769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597190400000",
    "number": "1205101862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7369 SHERIDAN ST STE 203",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330242776",
            "telephone_number": "954-983-5330",
            "fax_number": "954-983-5086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7369 SHERIDAN ST STE 203",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330242776",
            "telephone_number": "954-983-5330",
            "fax_number": "954-983-5086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALEXANDER PUSHKA MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-15",
        "last_updated": "2020-08-12",
        "certification_date": "2020-08-12",
        "status": "A",
        "authorized_official_last_name": "PUSHKA",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "954-579-1110",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "ME88666",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "FL",
            "license": "ME88666",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICAID NUMBER",
            "identifier": "004704500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hollywood, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.