Obsidian Healthcare LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

OBSIDIAN HEALTHCARE LLC

Practice address

3379 W Woolbright Rd
Boynton Beach, FL 33436-7245

Phone

(561) 449-0066

Fax

(561) 834-2511

NPI assigned

Feb 17, 2023

Organization subpart

No

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

Authorized official

Name

Mr. Jude Acloque, MDNPI 1386085314

Title

Authorized Official

Phone

(561) 443-0066

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 1

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

• Jude Andre Acloque, M.D.

  • Internal Medicine Physician
  • Boynton Beach, FL
  • NPI 1386085314
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1676592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676592000000",
    "number": "1447958699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3379 W WOOLBRIGHT RD",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334367245",
            "telephone_number": "561-449-0066",
            "fax_number": "561-834-2511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3379 W WOOLBRIGHT RD",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334367245",
            "telephone_number": "561-449-0066",
            "fax_number": "561-834-2511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OBSIDIAN HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-17",
        "last_updated": "2023-02-17",
        "certification_date": "2023-02-17",
        "status": "A",
        "authorized_official_last_name": "ACLOQUE",
        "authorized_official_first_name": "JUDE",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "561-443-0066",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "ME133297",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Boynton Beach, FL
• Providers in Boynton Beach, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 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.