Individual provider Active NPI

Holly Leigh Neville, MD

  • Pediatric Surgery Physician
  • Hollywood, FL
National Provider Identifier
1245339969
Registry record updated Feb 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Surgery PhysicianTaxonomy code 2086S0120X
License
ME89187 Issued in FL
Practice address
1150 N 35TH Ave Ste 555
Hollywood, FL 33021
Phone
(954) 265-0072
Fax
(954) 981-0188
NPI assigned
Sep 21, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Surgery Physician 2086S0120X ME89187 FL Primary

Addresses

Primary practice location

1150 N 35TH Ave Ste 555
Hollywood, FL 33021

Mailing address

2900 Corporate Way
Door D
Miramar, FL 33025-3925
Phone (954) 276-5685

Other practice location 1

1951 SW 172nd Ave Ste 204
Miramar, FL 33029-5613
Phone (954) 265-0072

Other practice location 2

3377 S State Rd 7
Suite 100
Wellington, FL 33449
Phone (561) 341-7000

Other identifiers 1

IdentifierTypeStateIssuer
2689413-00MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rmoore211019@MHSDIRECT.NET Direct

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
I20040922001040 FL Practitioner - General SurgeryPractitioner - Pediatric Medicine 6002884426 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME89187FLMDPediatric Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
South Broward Hospital District Pediatric Surgery CurrentSince Jun 25, 2019 Accepting new patients
South Broward Hospital District CurrentSince Jun 25, 2019 Accepting new patients
South Broward Hospital District Past Accepting new patients

Locations

20803 Biscayne Blvd
Ste 204
Aventura, FL 33180
Phone (954) 844-4480

1150 N 35th Ave
Ste 555
Hollywood, FL 33021
Phone (954) 981-0072

1951 SW 172nd Ave
Ste 204
Miramar, FL 33029
Phone (954) 967-9400

2900 Corporate Way
#D
Miramar, FL 33025
Phone (954) 276-5581

1971 SW 172nd Ave
Ste 2500
Miramar, FL 33029
Phone (954) 265-6333

Interoperability endpoints

  • Direct secure messaging: rmoore211019@mhsdirect.net

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643760000000",
    "number": "1245339969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 CORPORATE WAY",
            "address_2": "DOOR D",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330253925",
            "telephone_number": "954-276-5685",
            "fax_number": "954-985-7074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 N 35TH AVE STE 555",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "33021",
            "telephone_number": "954-265-0072",
            "fax_number": "954-981-0188"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1951 SW 172nd Ave Ste 204",
            "address_purpose": "LOCATION",
            "city": "Miramar",
            "state": "FL",
            "postal_code": "330295613",
            "country_code": "US",
            "telephone_number": "954-265-0072",
            "fax_number": "954-981-0188",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3377 S State Rd 7",
            "address_2": "Suite 100",
            "address_purpose": "LOCATION",
            "city": "Wellington",
            "state": "FL",
            "postal_code": "33449",
            "country_code": "US",
            "telephone_number": "561-341-7000",
            "fax_number": "561-784-7098",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NEVILLE",
        "first_name": "HOLLY",
        "middle_name": "LEIGH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-21",
        "last_updated": "2022-02-02",
        "certification_date": "2022-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "FL",
            "license": "ME89187",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2689413-00",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rmoore211019@MHSDIRECT.NET",
            "affiliation": "N",
            "endpointDescription": "MHS DSM",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1150 N 35th Ave Ste 555",
            "city": "Hollywood",
            "state": "FL",
            "country_code": "US",
            "postal_code": "33021",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hollywood, FL

Sources for this page

Verify at the official NPI Registry.