NPIMap

Organization Active NPI

Dynamic Healthcare Providers

  • Community/Behavioral Health Agency
  • Oakland Park, FL
National Provider Identifier
1659695831
Registry record updated Jan 5, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
MH3876 Issued in FL
Legal business name
DYNAMIC HEALTHCARE PROVIDERS
Practice address
2901 W Oakland Park Blvd
#A1
Oakland Park, FL 33311-1243
Phone
(954) 202-9334
Fax
(954) 202-7912
NPI assigned
Mar 17, 2010
Last updated
Jan 5, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2017

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

Authorized official

Name
Dr. Samuel E Kelly, ED.D., PH.DNPI 1669797171
Title
Clinician
Phone
(954) 202-9334

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X MH3876 FL
Community/Behavioral Health Agency 251S00000X MH3876 FL Primary

Addresses

Primary practice location

2901 W Oakland Park Blvd
#A1
Oakland Park, FL 33311-1243

Mailing address

2901 W Oakland Park Blvd
#A1
Oakland Park, FL 33311-1243
Phone (954) 202-9334

Other identifiers 2

IdentifierTypeStateIssuer
676033396MedicaidFL
676033398MedicaidFL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1268784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1483574400000",
    "number": "1659695831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 W OAKLAND PARK BLVD",
            "address_2": "#A1",
            "city": "OAKLAND PARK",
            "state": "FL",
            "postal_code": "333111243",
            "telephone_number": "954-202-9334",
            "fax_number": "954-202-7912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 W OAKLAND PARK BLVD",
            "address_2": "#A1",
            "city": "OAKLAND PARK",
            "state": "FL",
            "postal_code": "333111243",
            "telephone_number": "954-202-9334",
            "fax_number": "954-202-7912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC HEALTHCARE PROVIDERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-17",
        "last_updated": "2017-01-05",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CLINICIAN",
        "authorized_official_telephone_number": "954-202-9334",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "ED.D., PH.D"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "FL",
            "license": "MH3876",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "FL",
            "license": "MH3876",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "676033396",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "676033398",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakland Park, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.