Individual provider Active NPI

Osvaldo Bermudez Rodriguez

  • Adult Health Nurse Practitioner
  • Tamarac, FL
National Provider Identifier
1497024053
Registry record updated Dec 27, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
9275138 Issued in FL
Practice address
8013 NW 104TH Ave
Tamarac, FL 33321-1135
Phone
(954) 591-9380
NPI assigned
Dec 27, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 27, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 9275138 FL Primary

Addresses

Primary practice location

8013 NW 104TH Ave
Tamarac, FL 33321-1135

Mailing address

8013 NW 104TH Ave
Tamarac, FL 33321-1135
Phone (954) 591-9380

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120712000239 FL Practitioner - Nurse Practitioner 3375708654

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
9275138FLMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Prohealth Select, Inc. PastSince Dec 17, 2020 Accepting new patients
Professional Surgical Services PLLC Past Accepting new patients
Health Consulting Associates LLC PastSince Oct 20, 2015 Accepting new patients

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1324944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324944000000",
    "number": "1497024053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8013 NW 104TH AVE",
            "city": "TAMARAC",
            "state": "FL",
            "postal_code": "333211135",
            "telephone_number": "954-591-9380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8013 NW 104TH AVE",
            "city": "TAMARAC",
            "state": "FL",
            "postal_code": "333211135",
            "telephone_number": "954-591-9380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERMUDEZ RODRIGUEZ",
        "first_name": "OSVALDO",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-12-27",
        "last_updated": "2011-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "9275138",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tamarac, FL

Sources for this page

Verify at the official NPI Registry.