Individual provider Active NPI

Jean Max Saint Charles, MD

  • General Practice Physician
  • Lauderdale Lakes, FL
National Provider Identifier
1629466727
Registry record updated Nov 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
ACN836 Issued in FL
Practice address
4700 N State Road 7
Lauderdale Lakes, FL 33319-5800
Phone
(954) 730-7284
NPI assigned
Dec 26, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 12, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ACN836 FL
General Practice Physician 208D00000X 18979 PR
General Practice Physician 208D00000X ACN836 FL Primary

Addresses

Primary practice location

4700 N State Road 7
Lauderdale Lakes, FL 33319-5800

Mailing address

4740 N State Road 7
Lauderdale Lakes, FL 33319-5839
Phone (954) 486-4005

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ACN836FLMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Centro Medico del Turabo Inc General Practice CurrentSince Jan 1, 2016 Accepting new patients
Cossma Inc CurrentSince Jun 1, 2015 Accepting new patients
Cossma, Inc. CurrentSince Jun 1, 2015 Accepting new patients
Henderson Behavioral Health, Inc. CurrentSince Nov 20, 2020 Accepting new patients
Centro Medico del Turabo Inc CurrentSince Jan 1, 2016 Accepting new patients

Locations

330 SW 27th Ave
Ft Lauderdale, FL 33312
Phone (954) 463-0911

4700 N State Road 7
Lauderdale Lakes, FL 33319
Phone (954) 730-7284

4740 N State Road 7
Ste 201
Lauderdale Lakes, FL 33319
Phone (954) 497-3850

100 Ave Luis Munoz Marin
Caguas, PR 00725
Phone (787) 423-2261

Organizations & group practices 5

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": "1419552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605139200000",
    "number": "1629466727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4740 N STATE ROAD 7",
            "city": "LAUDERDALE LAKES",
            "state": "FL",
            "postal_code": "333195839",
            "telephone_number": "954-486-4005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 N STATE ROAD 7",
            "city": "LAUDERDALE LAKES",
            "state": "FL",
            "postal_code": "333195800",
            "telephone_number": "954-730-7284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAINT CHARLES",
        "first_name": "JEAN MAX",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-12-26",
        "last_updated": "2020-11-12",
        "certification_date": "2020-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ACN836",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PR",
            "license": "18979",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "ACN836",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lauderdale Lakes, FL

Sources for this page

Verify at the official NPI Registry.