Odalys Mederos, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9105763 Issued in FL

Practice address

1770 E Hallandale Beach Blvd
Hallandale Beach, FL 33009-4611

Phone

(954) 458-2572

Fax

(954) 354-8151

NPI assigned

Dec 15, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• William E. Sanchez, MD PA

  • Primary Care Clinic/Center
  • Miramar, FL
  • NPI 1356556443
  Medicare reassignment
• Sergio a Beltran MD PA

  • Internal Medicine Physician
  • Miramar, FL
  • NPI 1043303605
  NPD (past)

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

{
    "created_epoch": "1292371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445385600000",
    "number": "1497058358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1770 E HALLANDALE BEACH BLVD",
            "city": "HALLANDALE BEACH",
            "state": "FL",
            "postal_code": "330094611",
            "telephone_number": "954-458-2572",
            "fax_number": "954-354-8151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1770 E HALLANDALE BEACH BLVD",
            "city": "HALLANDALE BEACH",
            "state": "FL",
            "postal_code": "330094611",
            "telephone_number": "954-458-2572",
            "fax_number": "954-354-8151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDEROS",
        "first_name": "ODALYS",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-12-15",
        "last_updated": "2015-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9105763",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Joachim McKenzie, M.D.
• Michelle McPhillip, PHYSICAL THERAPIST
• MD Now Medical Centers, Inc
• Meals Direct of Florida, LLC
• Med Wellness Care LLC
• Medical & Co. LLC
• Medical Equipment Group Inc
• Mefl, LLC
• Denise Yvette Melendez
• Memorial Healthcare System

• Physician Assistant in Hallandale Beach, FL
• Providers in Hallandale Beach, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.