NPIMap

Organization Active NPI

Prestige Recovery and Suboxone Clinic LLC

Doing business as Prestige Concierge Psychiatry

  • Psychiatry Physician
  • Fort Lauderdale, FL
National Provider Identifier
1215623624
Registry record updated Mar 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
PRESTIGE RECOVERY AND SUBOXONE CLINIC LLC
Doing business as
Prestige Concierge Psychiatry
Practice address
3800 W Broward Blvd
Fort Lauderdale, FL 33312-1018
Phone
(954) 496-2599
NPI assigned
Apr 18, 2023
Last updated
Mar 20, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2024

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

Authorized official

Name
Henry OdazieNPI 1740880848
Title
Ceo
Phone
(954) 496-2599

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X Primary
Adult Mental Health Clinic/Center 261QM0850X

Addresses

Primary practice location

3800 W Broward Blvd
Fort Lauderdale, FL 33312-1018

Mailing address

3800 W Broward Blvd
Fort Lauderdale, FL 33312-1018
Phone (954) 496-2599

Other practice location 1

2378 Great Harbor Dr
Kissimmee, FL 34746-3596
Phone (954) 496-2599

Other names 1

  • PRESTIGE CONCIERGE PSYCHIATRY Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230615003263 FL Part B Supplier - Clinic/Group Practice 7416315882 Receives reassigned benefits from 11 practitioners
Practice locations: Orlando, FL; Kissimmee, FL; Fort Myers, FL; Fort Lauderdale, FL

National Provider Directory

National Provider Directory

Locations

7191 Cypress Lake Dr
Ste 3
Fort Myers, FL 33907
Phone 9542710291201

3800 W Broward Blvd
Ft Lauderdale, FL 33312
Phone (941) 204-2635

406 E Vine St
Rm C
Kissimmee, FL 34744
Phone 9542710291201

Networks

  • HealthSun Health Plans Network

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1681776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710892800000",
    "number": "1215623624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3800 W BROWARD BLVD",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333121018",
            "telephone_number": "954-496-2599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3800 W BROWARD BLVD",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333121018",
            "telephone_number": "954-496-2599"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2378 Great Harbor Dr",
            "address_purpose": "LOCATION",
            "city": "Kissimmee",
            "state": "FL",
            "postal_code": "347463596",
            "country_code": "US",
            "telephone_number": "954-496-2599",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PRESTIGE RECOVERY AND SUBOXONE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-18",
        "last_updated": "2024-03-20",
        "certification_date": "2024-03-20",
        "status": "A",
        "authorized_official_last_name": "ODAZIE",
        "authorized_official_first_name": "HENRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "954-496-2599"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PRESTIGE CONCIERGE PSYCHIATRY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PRESTIGE CONCIERGE PSYCHIATRY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Lauderdale, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2024; 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.