Individual provider Active NPI

Jordan Harris Shapiro, D.M.D.

  • Oral and Maxillofacial Surgery (Dentist)
  • Pembroke Pines, FL
National Provider Identifier
1225562549
Registry record updated May 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
DN26579 Issued in FL
Practice address
17901 NW 5TH St Ste 101
Pembroke Pines, FL 33029-2810
Phone
(954) 437-2222
Fax
(954) 437-2244
NPI assigned
Apr 13, 2017
Last updated
May 21, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X DN26579 FL Primary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X DL13293 MA
Student in an Organized Health Care Education/Training Program 390200000X NU

Addresses

Primary practice location

17901 NW 5TH St Ste 101
Pembroke Pines, FL 33029-2810

Mailing address

17901 NW 5TH St Ste 101
Pembroke Pines, FL 33029-2810
Phone (954) 437-2222

Other practice location 1

2600 N Military Trl Ste 350
Boca Raton, FL 33431-6315
Phone (561) 465-2059

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240126000495 FL Practitioner - Oral SurgeryPractitioner - Maxillofacial Surgery 6204108210 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Oral SurgeryAlso: Maxillofacial Surgery
Education
Tufts University School of Dental Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alfredo Tendler DMD PAGroup PAC ID 8729244348, 3 clinicians

Practice addresses (Care Compare)

17901 NW 5TH St
Suite 101
Pembroke Pines, FL 33029-2810
Phone (954) 437-2222

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision19

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN26579FLMDOral and Maxillofacial Surgery (Dentist)

Practice roles

OrganizationSpecialtyStatusNew patients
Flocoms, PLLC Oral and Maxillofacial Surgery CurrentSince Sep 26, 2023 Accepting new patients

Locations

2600 N Military Trl
Ste 350
Boca Raton, FL 33431
Phone (561) 425-2059

17901 NW 5th St
Ste 101
Pembroke Pines, FL 33029
Phone (954) 437-2222

17901 NW 5th St
Ste 102
Pembroke Pines, FL 33029
Phone (954) 435-1270

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1492041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716249600000",
    "number": "1225562549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17901 NW 5TH ST STE 101",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330292810",
            "telephone_number": "954-437-2222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17901 NW 5TH ST STE 101",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330292810",
            "telephone_number": "954-437-2222",
            "fax_number": "954-437-2244"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2600 N Military Trl Ste 350",
            "address_purpose": "LOCATION",
            "city": "Boca Raton",
            "state": "FL",
            "postal_code": "334316315",
            "country_code": "US",
            "telephone_number": "561-465-2059",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAPIRO",
        "first_name": "JORDAN",
        "middle_name": "HARRIS",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-13",
        "last_updated": "2024-05-21",
        "certification_date": "2024-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "FL",
            "license": "DN26579",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MA",
            "license": "DL13293",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pembroke Pines, FL

Sources for this page

Verify at the official NPI Registry.