East Ft Lauderdale LLC

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

EAST FT LAUDERDALE LLC

Practice address

1301 S Andrews Ave
Ste 101
Ft Lauderdale, FL 33316-1823

Phone

(954) 761-1273

Fax

(954) 467-0384

NPI assigned

Apr 26, 2006

Organization subpart

No

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

Authorized official

Name

Samuel T Wey

Title

VP, Licensure & Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• East Ft Lauderdale Dialysis Center Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• Bainbridge Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Fort Worth, TX
  • NPI 1699041152

  Member Of

  NPD member
• Renal Treatment Centers-Southeast, LP.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Donna, TX
  • NPI 1902353543

  Member Of

  NPD member

Networks

• Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Maximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…
• HealthSun Health Plans Network
• Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706400000000",
    "number": "1285690248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L&C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569",
            "telephone_number": "615-320-4593",
            "fax_number": "800-293-5872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 S ANDREWS AVE",
            "address_2": "STE 101",
            "city": "FT LAUDERDALE",
            "state": "FL",
            "postal_code": "333161823",
            "telephone_number": "954-761-1273",
            "fax_number": "954-467-0384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST FT LAUDERDALE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-26",
        "last_updated": "2024-01-28",
        "certification_date": "2024-01-28",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "VP,  LICENSURE & CERTIFICATION",
        "authorized_official_telephone_number": "615-341-6641"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890219400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Ft Lauderdale Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "East Ft Lauderdale Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• East Broward Dental
• East Coast Family Dental Lauderdale PA
• East Coast Pathology Associates, PA
• East Commercial Childrens Dental
• East Fort Lauderdale ASC LLC
• East Las Olas Psychological Group
• East Las Olas Psychological Group
• East/West Pediatrics, P.a.
• Eastern Acupuncture Fort Lauderdale
• Eastside Dermatology, PA

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Ft Lauderdale, FL
• Providers in Ft Lauderdale, FL by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.