Jonathan Wideroff, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

ME35997 Issued in FL

Practice address

1601 Clint Moore Rd Ste 145
Boca Raton, FL 33487-5720

Phone

(561) 288-2537

Fax

(561) 939-5460

NPI assigned

Oct 12, 2005

Last updated

Sep 24, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Tenet Florida Physician Services LLC

  • Surgery Physician
  • West Palm Beach, FL
  • NPI 1659417467
  Medicare reassignment NPD
• South Palm Beach Surgical Associates, PL

  • Surgery Physician
  • Boca Raton, FL
  • NPI 1750662912
  Authorized official Same address or phone
• Tenet Florida Physician Services, LLC

  • Physical Therapist
  • West Palm Beach, FL
  • NPI 1699111211
  NPD

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

{
    "created_epoch": "1129075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600905600000",
    "number": "1215925367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 CLINT MOORE RD",
            "address_2": "SUITE 145",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334872768",
            "telephone_number": "561-939-0455",
            "fax_number": "561-939-5460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 CLINT MOORE RD STE 145",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334875720",
            "telephone_number": "561-288-2537",
            "fax_number": "561-939-5460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDEROFF",
        "first_name": "JONATHAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-12",
        "last_updated": "2020-09-24",
        "certification_date": "2020-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME35997",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "FL",
            "license": "ME35997",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wholesome Family Wellness LLC
• Wholesome Therapy Center Inc
• Paul Whritenour
• Lloyd George Wickboldt, MD
• Hollis Widdekind, LCSW
• Brian Adam Wiederhold, PA-C
• Martin Wiederkehr, B.S. PHARM
• David Wiederman
• Jonathan I Wiener, M.D.
• Wiernicki & Senyshyn P.a.

• Surgery Physician in Boca Raton, FL
• Providers in Boca Raton, FL by specialty
• Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.