Supra Medical Group

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

SUPRA MEDICAL GROUP

Practice address

201 NW 70TH Ave Ste a
Plantation, FL 33317-2369

Phone

(305) 485-1532

Fax

(305) 485-1534

NPI assigned

Jan 20, 2014

Organization subpart

No

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

Authorized official

Name

Rafael Sosa

Title

Owner

Phone

(305) 485-1532

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Martine Pierre, PA-C

  • Medical Physician Assistant
  • Plantation, FL
  • NPI 1184886459
  NPD (past)

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

{
    "created_epoch": "1390176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1285056663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 NW 70TH AVE STE A",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333172369",
            "telephone_number": "305-485-1532",
            "fax_number": "305-485-1534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 NW 70TH AVE STE A",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333172369",
            "telephone_number": "305-485-1532",
            "fax_number": "305-485-1534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPRA MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-20",
        "last_updated": "2022-07-21",
        "certification_date": "2021-11-22",
        "status": "A",
        "authorized_official_last_name": "SOSA",
        "authorized_official_first_name": "RAFAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "305-485-1532"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCA",
            "identifier": "HCC10035",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Plantation, FL
• Providers in Plantation, FL by specialty
• Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.