Ortho Florida, LLC

Primary specialty

Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X

Legal business name

ORTHO FLORIDA, LLC

Doing business as

Johannes V. Blom, M.D.

Practice address

3702 Washington St Ste 202
Hollywood, FL 33021-8283

Phone

(954) 964-6114

NPI assigned

Nov 7, 2017

Last updated

Nov 7, 2017By the provider in NPPES

Organization subpart

Yes

Parent organization

ORTHO FLORIDA, LLCAs reported in NPPES

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

Authorized official

Name

Dane Trask

Title

Ceo

Phone

(813) 787-1128

Specialties & licenses 1

Addresses

Other names 1

• Johannes V. Blom, M.D. Doing business as

Part of

Ortho Florida LLC

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

{
    "created_epoch": "1510012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510012800000",
    "number": "1225541790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "751 PARK OF COMMERCE DR STE 112",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334873622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3702 WASHINGTON ST STE 202",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330218283",
            "telephone_number": "954-964-6114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHO FLORIDA, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ORTHO FLORIDA, LLC",
        "enumeration_date": "2017-11-07",
        "last_updated": "2017-11-07",
        "status": "A",
        "authorized_official_last_name": "TRASK",
        "authorized_official_first_name": "DANE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "813-787-1128"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Johannes V. Blom, M.D.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ninoucheka Orleans
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• Orthopaedic Associates of South Broward PA
• Orthopaedic Rehab Ergonmics
• Orthopedic and Surgery Center LLC
• Orthopedic and Surgery Center LLC (Hollywood Spine and Rehabilitation)

• Sports Medicine (Orthopaedic Surgery) Physician in Hollywood, FL
• Providers in Hollywood, FL by specialty
• Sports Medicine (Orthopaedic Surgery) Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2017; 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.