Jeff Thackrey, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

ME93287 Issued in FL

Practice address

6400 N Andrews Ave
Ste 120
Fort Lauderdale, FL 33309-2114

Phone

(954) 688-4072

Fax

(954) 653-7209

NPI assigned

Jun 18, 2010

Last updated

Oct 15, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jun 28, 2012 through Jun 28, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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

• Lauderdale Health and Wellness Inc.

  dba BodyLogicMD of Fort Lauderdale

  • Preventive Medicine/Occupational Environmental Medicine Physician
  • Fort Lauderdale, FL
  • NPI 1255573879
  NPD (past) Authorized official

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

{
    "created_epoch": "1276819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413331200000",
    "number": "1306167846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6400 N ANDREWS AVE",
            "address_2": "STE 120",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333092114",
            "telephone_number": "954-688-4072",
            "fax_number": "954-653-7209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6400 N ANDREWS AVE",
            "address_2": "STE 120",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333092114",
            "telephone_number": "954-688-4072",
            "fax_number": "954-653-7209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THACKREY",
        "first_name": "JEFF",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-06-18",
        "last_updated": "2014-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME93287",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Selamawit Tesfamariam
• Callie Teuton
• TFPS IV, L.L.C. (Florida Institute of Orthopaedic Surgical Specialists)
• Romon Thach, STUDENT, HEALTHCARE
• Chelsey Ann Thachettu, DO
• Vikram V Thakar, DPM
• Harish D Thaker, MD
• Noah Thaman
• Paula Michele Thaqi, M.D.
• Rashida Tharpe

• Specialist in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.