Individual provider Active NPI

Jackson George Cohen, M.D.

  • Interventional Pain Medicine Physician
  • Hollywood, FL
National Provider Identifier
1467770248
Registry record updated Mar 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
ME116519 Issued in FL
Practice address
3702 Washington St Ste 303
Hollywood, FL 33021
Phone
(954) 518-2424
Fax
(954) 981-3476
NPI assigned
May 4, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine Physician 208VP0014X ME116519 FL Primary

Addresses

Primary practice location

3702 Washington St Ste 303
Hollywood, FL 33021

Mailing address

2900 Corporate Way
Door D
Miramar, FL 33025-3925
Phone (954) 276-5685

Other identifiers 1

IdentifierTypeStateIssuer
018258400MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jcohen152616@MHSDIRECT.NET Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150921000447 FL Practitioner - Physical Medicine and RehabilitationPractitioner - Interventional Pain Management 7911214143 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and RehabilitationAlso: Interventional Pain Management
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Rehabclinics Pta IncGroup PAC ID 0547237497, shared by 11 NPIs, 209 clinicians
South Broward Hospital DistrictGroup PAC ID 8123927373, 659 clinicians

Practice addresses (Care Compare)

13645 Biscayne Blvd
North Miami Beach, FL 33181-1617
Phone (305) 949-2700

3702 Washington St
Suite 303
Hollywood, FL 33021-8287
Phone (954) 518-2424

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME116519FLMDInterventional Pain Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
South Broward Hospital District CurrentSince Jan 28, 2017 Accepting new patients
South Broward Hospital District CurrentSince Jan 28, 2017 Accepting new patients
Synovation Medical Group, LLC Interventional Pain Medicine CurrentSince Aug 24, 2015 Accepting new patients
South Broward Hospital District Past Accepting new patients

Locations

2500 E Hallandale Beach Blvd
Ste 211
Hallandale Beach, FL 33009
Phone (954) 456-5533

3702 Washington St
Ste 303
Hollywood, FL 33021
Phone (954) 265-8326

925 NE 30th Ter
Ste 206
Homestead, FL 33033
Phone (305) 246-1265

2900 Corporate Way
#D
Miramar, FL 33025
Phone (954) 276-5581

3501 Johnson St
Pembroke Park, FL 33021
Phone (954) 265-2000

7000 SW 62nd Ave
Ste 535
South Miami, FL 33143
Phone (786) 268-4044

Interoperability endpoints

  • Direct secure messaging: jcohen152616@mhsdirect.net

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1272931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615766400000",
    "number": "1467770248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 CORPORATE WAY",
            "address_2": "DOOR D",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330253925",
            "telephone_number": "954-276-5685",
            "fax_number": "954-985-7074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3702 WASHINGTON ST STE 303",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "33021",
            "telephone_number": "954-518-2424",
            "fax_number": "954-981-3476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COHEN",
        "first_name": "JACKSON",
        "middle_name": "GEORGE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-05-04",
        "last_updated": "2021-03-15",
        "certification_date": "2021-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "FL",
            "license": "ME116519",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "018258400",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jcohen152616@MHSDIRECT.NET",
            "affiliation": "N",
            "endpointDescription": "MHS DSM",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3702 Washington St Ste 303",
            "city": "Hollywood",
            "state": "FL",
            "country_code": "US",
            "postal_code": "33021",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hollywood, FL

Sources for this page

Verify at the official NPI Registry.