NPIMap

Organization Active NPI

Osteopathic Medical Arts Center of South Florida LLC

  • Family Medicine Physician
  • Hollywood, FL
National Provider Identifier
1316412836
Registry record updated Jul 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
OSTEOPATHIC MEDICAL ARTS CENTER OF SOUTH FLORIDA LLC
Practice address
3700 Washington St Ste 401
Hollywood, FL 33021-8249
Phone
(954) 955-6622
Fax
(888) 809-1631
NPI assigned
Oct 11, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2020

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

Authorized official

Name
Serge Gardere, DONPI 1275838542
Title
Owner
Phone
(954) 381-7334

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neuromusculoskeletal Medicine & OMM PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 204D00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

3700 Washington St Ste 401
Hollywood, FL 33021-8249

Mailing address

1201 NE 26TH St Ste 109
Wilton Manors, FL 33305-1206
Phone (954) 838-1173

Other practice location 1

1201 NE 26th St Ste 109
Wilton Manors, FL 33305-1206
Phone (813) 754-7756

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190516000152 FL Part B Supplier - Clinic/Group Practice 9830432707 Receives reassigned benefits from 2 practitioners
Practice locations: Hollywood, FL; Wilton Manors, FL

National Provider Directory

National Provider Directory

Locations

1201 NE 26th St
Ste 109
Wilton Manors, FL 33305
Phone (954) 381-7334

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1539216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595376000000",
    "number": "1316412836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 NE 26TH ST STE 109",
            "city": "WILTON MANORS",
            "state": "FL",
            "postal_code": "333051206",
            "telephone_number": "954-838-1173",
            "fax_number": "888-809-1631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3700 WASHINGTON ST STE 401",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330218249",
            "telephone_number": "954-955-6622",
            "fax_number": "888-809-1631"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1201 NE 26th St Ste 109",
            "address_purpose": "LOCATION",
            "city": "Wilton Manors",
            "state": "FL",
            "postal_code": "333051206",
            "country_code": "US",
            "telephone_number": "813-754-7756",
            "fax_number": "813-754-7756",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OSTEOPATHIC MEDICAL ARTS CENTER OF SOUTH FLORIDA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-11",
        "last_updated": "2020-07-22",
        "certification_date": "2020-07-22",
        "status": "A",
        "authorized_official_last_name": "GARDERE",
        "authorized_official_first_name": "SERGE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "954-381-7334",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "204D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hollywood, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2020; 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.