Individual provider Active NPI

Brendan Lally

  • Emergency Medicine Physician
  • Fort Lauderdale, FL
National Provider Identifier
1649658949
Registry record updated Jan 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
ME136054 Issued in FL
Practice address
1600 S Andrews Ave
Fort Lauderdale, FL 33316-2510
Phone
(954) 355-5199
NPI assigned
May 7, 2015
Last updated
Jan 15, 2019By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 15, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X ME136054 FL Primary

Addresses

Primary practice location

1600 S Andrews Ave
Fort Lauderdale, FL 33316-2510

Mailing address

1721 SE 17TH St Apt 451
Fort Lauderdale, FL 33316-3142
Phone (727) 686-4630

Other practice location 1

475 Seaview Ave
Staten Island, NY 10305-3436
Phone (718) 226-1548

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
I20181212002677 FL Practitioner - Emergency Medicine 0143565549 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Meharry Medical College School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1600 S Andrews Ave
Fort Lauderdale, FL 33316-2510
Phone (954) 939-5000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Phoenix Emergency Medicine of Broward LLC Emergency Medicine Current Accepting new patients
Phoenix Emergency Medicine of Broward LLC Emergency Medicine CurrentSince Jun 30, 2018 Accepting new patients
Phoenix Emergency Medicine of Broward LLC Emergency Medicine CurrentSince Jun 30, 2018 Accepting new patients

Locations

1600 S Andrews Ave
Ft Lauderdale, FL 33316
Phone (954) 355-4000

3114 Croasdaile Dr
#200
Durham, NC 27705
Phone (877) 751-1157

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1430956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547510400000",
    "number": "1649658949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1721 SE 17TH ST APT 451",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333163142",
            "telephone_number": "727-686-4630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 S ANDREWS AVE",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333162510",
            "telephone_number": "954-355-5199"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "475 Seaview Ave",
            "address_purpose": "LOCATION",
            "city": "Staten Island",
            "state": "NY",
            "postal_code": "103053436",
            "country_code": "US",
            "telephone_number": "718-226-1548",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LALLY",
        "first_name": "BRENDAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-05-07",
        "last_updated": "2019-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "ME136054",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Lauderdale, FL

Sources for this page

Verify at the official NPI Registry.