NPIMap

Organization Active NPI

Nova Southeastern University

  • Allergy & Immunology (Internal Medicine) Physician
  • Miami, FL
National Provider Identifier
1336477397
Registry record updated May 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy & Immunology (Internal Medicine) PhysicianTaxonomy code 207RA0201X
Legal business name
NOVA SOUTHEASTERN UNIVERSITY
Practice address
8501 SW 124TH Ave Ste 111
Miami, FL 33183-4631
Phone
(305) 275-2601
Fax
(305) 274-8075
NPI assigned
Dec 2, 2009
Last updated
May 24, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2023

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

Authorized official

Name
Rosemery Estevez
Title
Dir Contracting and Cred
Phone
(954) 262-4343

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X 680074-3 FL
Nurse Practitioner 363L00000X NU
Acupuncturist 171100000X NU
Allergy & Immunology Physician 207K00000X NU
Internal Medicine Physician 207R00000X NU
Allergy & Immunology (Internal Medicine) Physician 207RA0201X NU Primary

Addresses

Primary practice location

8501 SW 124TH Ave Ste 111
Miami, FL 33183-4631

Mailing address

PO Box 290370
Davie, FL 33329-0370
Phone (305) 275-2601

Other names 1

  • NSU - Center for Neuro Immune Disorders Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031118000987 FL Part B Supplier - Clinic/Group Practice 4486568896 Receives reassigned benefits from 259 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Davie, FL; Wilton Manors, FL; Sunrise, FL; Plantation, FL; North Miami Beach, FL; Miami, FL; Ft Lauderdale, FL; Fort Lauderdale, FL

Other NPIs on the same Medicare enrollment 22

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 22

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2177637Nova Southeastern University, Inc8501 SW 124TH Ave Ste 111a, Miami, FL 33183Certificate of waiverFeb 24, 2027

National Provider Directory

National Provider Directory
Tax ID family
Nova Southeastern Univ38 organizations share this tax ID, including this one

Other organizations with this tax ID 37

Organizations that report the same tax identification number in the National Provider Directory.

View all 37

Locations

8501 SW 124th Ave
Ste 111
Miami, FL 33183
Phone (305) 275-2601

8501 SW 124th Ave
Ste 111A
Miami, FL 33183

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1259712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684886400000",
    "number": "1336477397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 290370",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333290370",
            "telephone_number": "305-275-2601",
            "fax_number": "305-274-8075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8501 SW 124TH AVE STE 111",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331834631",
            "telephone_number": "305-275-2601",
            "fax_number": "305-274-8075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVA SOUTHEASTERN UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-02",
        "last_updated": "2023-05-24",
        "certification_date": "2023-05-24",
        "status": "A",
        "authorized_official_last_name": "ESTEVEZ",
        "authorized_official_first_name": "ROSEMERY",
        "authorized_official_title_or_position": "DIR CONTRACTING AND CRED",
        "authorized_official_telephone_number": "954-262-4343"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "FL",
            "license": "680074-3",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RA0201X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Allergy & Immunology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NSU - Center for Neuro Immune Disorders",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "NSU - Center for Neuro Immune Disorders",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Miami, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.