NPIMap

Organization Active NPI

Midland Medical Broward LLC

Doing business as Midland Wellness Centers

  • Family Medicine Physician
  • Oakland Park, FL
National Provider Identifier
1447305339
Registry record updated Sep 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS9305 Issued in FL
Legal business name
MIDLAND MEDICAL BROWARD LLC
Doing business as
Midland Wellness Centers
Practice address
1421 E Oakland Park Blvd Ste 200
Oakland Park, FL 33334-4434
Phone
(954) 565-0875
Fax
(954) 565-0876
NPI assigned
Jan 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2023

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

Authorized official

Name
Noah J Lee, DONPI 1275559106
Title
Director
Phone
(954) 565-0875

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
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X OS9305 FL Primary

Addresses

Primary practice location

1421 E Oakland Park Blvd Ste 200
Oakland Park, FL 33334-4434

Mailing address

1421 E Oakland Park Blvd Ste 200
Oakland Park, FL 33334-4434
Phone (954) 565-0875

Other identifiers 4

IdentifierTypeStateIssuer
7258838OtherFLAETNA
97941OtherFLBCBS
170442OtherFLHUMANA
2342763OtherFLAETNA HMO

Other names 1

  • Midland Wellness Centers Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070414000063 FL Part B Supplier - Clinic/Group Practice 3274638549 Receives reassigned benefits from 11 practitioners
Practice locations: Wilton Manors, FL; Tamarac, FL; Pembroke Pines, FL; Oakland Park, FL; Miami, FL; Ft Lauderdale, FL; Boca Raton, FL

National Provider Directory

National Provider Directory

Locations

2817 E Oakland Park Blvd
Ste 302
Fort Lauderdale, FL 33306

1421 E Oakland Park Blvd
Ste 200
Oakland Park, FL 33334
Phone (954) 375-1276

1421 E Oakland Park Blvd
Ste 101
Oakland Park, FL 33334
Phone (561) 763-7629

Networks

  • HealthSun Health Plans Network

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693872000000",
    "number": "1447305339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1421 E OAKLAND PARK BLVD STE 200",
            "city": "OAKLAND PARK",
            "state": "FL",
            "postal_code": "333344434",
            "telephone_number": "954-565-0875",
            "fax_number": "954-565-0876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1421 E OAKLAND PARK BLVD STE 200",
            "city": "OAKLAND PARK",
            "state": "FL",
            "postal_code": "333344434",
            "telephone_number": "954-565-0875",
            "fax_number": "954-565-0876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDLAND MEDICAL BROWARD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-24",
        "last_updated": "2023-09-05",
        "certification_date": "2023-09-05",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "NOAH",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "954-565-0875",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS9305",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7258838",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "97941",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "170442",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "2342763",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Midland Wellness Centers",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Midland Wellness Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oakland Park, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2023; 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.