Individual provider Active NPI

Peach Supupramai, DO

  • Student in an Organized Health Care Education/Training Program
  • Fort Lauderdale, FL
National Provider Identifier
1235766296
Registry record updated Mar 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
1600 S Andrews Ave
Fort Lauderdale, FL 33316-2510
Phone
(954) 355-4400
NPI assigned
Mar 26, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

1600 S Andrews Ave
Fort Lauderdale, FL 33316-2510

Mailing address

1600 S Andrews Ave
Fort Lauderdale, FL 33316-2510

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
I20231012003871 FL Practitioner - Family Practice 2163877093 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Holy Cross Hospital IncGroup PAC ID 1850298365, 299 clinicians

Practice addresses (Care Compare)

4004 N Ocean Blvd
Holy Cross Medical Group
Ft Lauderdale, FL 33308-6420
Phone (954) 564-1330

Hospital & facility affiliations

  • Trilogy Home Healthcare Home health agency, Coral Springs, FL, CCN 108061
  • Holy Cross Hospital Hospital, Ft Lauderdale, FL, CCN 100073

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Holy Cross Hospital Inc CurrentSince Jul 10, 2023 Accepting new patients
Holy Cross Hospital, Inc CurrentSince Jul 10, 2023 Accepting new patients

Locations

1900 E Commercial Blvd
Ste 101
Ft Lauderdale, FL 33308
Phone (954) 351-5838

1900 E Commercial Blvd
Ste 202
Ft Lauderdale, FL 33308
Phone (954) 351-5840

4004 N Ocean Blvd
Ft Lauderdale, FL 33308
Phone (954) 542-1500

1309 S Federal Hwy
#G
Ft Lauderdale, FL 33316
Phone (954) 463-4383

Interoperability endpoints

  • Direct secure messaging: psupupramai2902531@direct.trinity-health.org

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1585180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585180800000",
    "number": "1235766296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 S ANDREWS AVE",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333162510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 S ANDREWS AVE",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333162510",
            "telephone_number": "954-355-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUPUPRAMAI",
        "first_name": "PEACH",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-26",
        "last_updated": "2020-03-26",
        "certification_date": "2020-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Lauderdale, FL

Sources for this page

Verify at the official NPI Registry.