Medi MD

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

License

0601 Issued in FL

Legal business name

MEDI MD

Practice address

7950 SW 30TH St Ste 200
Davie, FL 33328-1979

Phone

(888) 674-0160

Fax

(888) 467-1802

NPI assigned

Aug 31, 2008

Organization subpart

No

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

Authorized official

Name

Sebastian Ahmed

Title

Exec

Phone

(888) 674-0160

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• St Johns Wellness Group Other name

Locations

Practitioners 2

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

• Jason Fredrick Wagner, APRN, LMHC, MCAP

  • Psychiatric/Mental Health Nurse Practitioner
  • Hollywood, FL
  • NPI 1720536691
  NPD (past)
• Elaine Littlejohn Gennett, ARNP

  • Family Nurse Practitioner
  • Louisville, KY
  • NPI 1154431146
  NPD (past)

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

{
    "created_epoch": "1220140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1306094586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7950 SW 30TH ST STE 200",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333281979",
            "telephone_number": "888-674-0160",
            "fax_number": "866-467-1802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7950 SW 30TH ST STE 200",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333281979",
            "telephone_number": "888-674-0160",
            "fax_number": "888-467-1802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDI MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-31",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "AHMED",
        "authorized_official_first_name": "SEBASTIAN",
        "authorized_official_title_or_position": "EXEC",
        "authorized_official_telephone_number": "888-674-0160"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "FL",
            "license": "602238",
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "FL",
            "license": "0601",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DQ5523",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001991000",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "98322",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Johns Wellness Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Substance Use Disorder Rehabilitation Clinic/Center in Davie, FL
• Providers in Davie, FL by specialty
• Substance Use Disorder Rehabilitation 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.