NPIMap

Individual provider Active NPI

David Clifton Llewellyn Phillibert, MD

  • Surgery Physician
  • Miami Shores, FL
National Provider Identifier
1619210697
Registry record updated Oct 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
ME146466 Issued in FL
Practice address
9415 NE 6TH Ave
Miami Shores, FL 33138-2737
Phone
(786) 401-6455
NPI assigned
Mar 28, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X ME146466 FL Primary

Addresses

Primary practice location

9415 NE 6TH Ave
Miami Shores, FL 33138-2737

Mailing address

1100 Brickell Bay Dr Apt 67TH
Miami, FL 33131-3539
Phone (914) 714-2430

Other practice location 1

4900 W Oakland Park Blvd Ste 202
Lauderdale Lakes, FL 33313-1501
Phone (786) 401-6455

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211201000823 FL Practitioner - General Surgery 0749670081 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Pittsburgh School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Joseph Surgery LLCGroup PAC ID 5890957484, 2 clinicians

Practice addresses (Care Compare)

9415 NE 6TH Ave
Miami Shores, FL 33138-2737
Phone (786) 401-6455

Hospital & facility affiliations

  • North Shore Medical Center Hospital, Miami, FL, CCN 100029
  • Jackson Health System Hospital, Miami, FL, CCN 100022

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hernia repair - groin (open)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME146466FLMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Joseph Surgery LLC CurrentSince Sep 1, 2021 Accepting new patients

Locations

4900 W Oakland Park Blvd
Ste 107
Lauderdale Lakes, FL 33313
Phone (786) 401-6455

4900 W Oakland Park Blvd
Ste 202
Lauderdale Lakes, FL 33313
Phone (516) 418-4184

9415 NE 6th Ave
Miami Shores, FL 33138
Phone (305) 756-7899

Organizations & group practices 1

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.

Hospital & facility affiliations 25

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

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1364428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635379200000",
    "number": "1619210697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 BRICKELL BAY DR APT 67TH",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331313539",
            "telephone_number": "914-714-2430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9415 NE 6TH AVE",
            "city": "MIAMI SHORES",
            "state": "FL",
            "postal_code": "331382737",
            "telephone_number": "786-401-6455"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4900 W Oakland Park Blvd Ste 202",
            "address_purpose": "LOCATION",
            "city": "Lauderdale Lakes",
            "state": "FL",
            "postal_code": "333131501",
            "country_code": "US",
            "telephone_number": "786-401-6455",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHILLIBERT",
        "first_name": "DAVID",
        "middle_name": "CLIFTON LLEWELLYN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-03-28",
        "last_updated": "2021-10-28",
        "certification_date": "2021-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "FL",
            "license": "ME146466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami Shores, FL

Sources for this page

Verify at the official NPI Registry.