NPIMap

Organization Active NPI

Thoracic Innovation, LLC

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Davie, FL
National Provider Identifier
1326335548
Registry record updated Jul 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
ME106359 Issued in FL
Legal business name
THORACIC INNOVATION, LLC
Practice address
15053 SW 40TH St
Davie, FL 33331-2769
Phone
(340) 772-2000
NPI assigned
Jul 8, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2011

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

Authorized official

Name
Moses Degraft-Johnson, M.D.NPI 1194970475
Title
Physician/Owner
Phone
(340) 772-2000

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208G00000X ME106359 FL Primary

Addresses

Primary practice location

15053 SW 40TH St
Davie, FL 33331-2769

Mailing address

15053 SW 40TH St
Davie, FL 33331-2769

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1310083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311206400000",
    "number": "1326335548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15053 SW 40TH ST",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333312769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15053 SW 40TH ST",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333312769",
            "telephone_number": "340-772-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THORACIC INNOVATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-08",
        "last_updated": "2011-07-21",
        "status": "A",
        "authorized_official_last_name": "DEGRAFT-JOHNSON",
        "authorized_official_first_name": "MOSES",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "340-772-2000",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "FL",
            "license": "ME106359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Davie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2011; 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.