NPIMap

Organization Active NPI

Nova Southeastern University, Inc.

  • Sports Medicine (Family Medicine) Physician
  • Fort Lauderdale, FL
National Provider Identifier
1720126584
Registry record updated May 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
Legal business name
NOVA SOUTHEASTERN UNIVERSITY, INC.
Practice address
3301 College Ave
University Center Room 1433
Ft. Lauderdale, FL 33314-7721
Phone
(954) 262-5590
Fax
(954) 262-5570
NPI assigned
Feb 2, 2007
Last updated
May 24, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
NOVA SOUTHEASTERN UNIVERSITY, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 24, 2023

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

Authorized official

Name
Rosemery Estevez
Title
Dir of Contracting and Creden
Phone
(954) 262-4343

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X NU
Nutritionist 133N00000X NU
Registered Dietitian 133V00000X NU
Optometrist 152W00000X NU
Acupuncturist 171100000X NU
Neuromusculoskeletal Medicine & OMM Physician 204D00000X NU
Sports Medicine (Family Medicine) Physician 207QS0010X NU Primary
Physical Therapist 225100000X NU

Addresses

Primary practice location

3301 College Ave
University Center Room 1433
Ft. Lauderdale, FL 33314-7721

Mailing address

3200 S University Dr
Sanford L. Ziff BLDG, 3Rd Floor, Room 4364-D
Fort Lauderdale, FL 33328-2018
Phone (954) 262-4343

Other identifiers 1

IdentifierTypeStateIssuer
98673OtherFLMEDICARE GROUP NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031118000987 FL Part B Supplier - Clinic/Group Practice 4486568896 Receives reassigned benefits from 259 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Davie, FL; Wilton Manors, FL; Sunrise, FL; Plantation, FL; North Miami Beach, FL; Miami, FL; Ft Lauderdale, FL; Fort Lauderdale, FL

Other NPIs on the same Medicare enrollment 22

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 22

National Provider Directory

National Provider Directory
Tax ID family
Nova Southeastern Univ38 organizations share this tax ID, including this one
Part of
Nova Southeastern Univ

Other organizations with this tax ID 37

Organizations that report the same tax identification number in the National Provider Directory.

View all 37

Practitioners & affiliated clinicians

Practitioners 21

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.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684886400000",
    "number": "1720126584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 S UNIVERSITY DR",
            "address_2": "SANFORD L. ZIFF BLDG, 3RD FLOOR, ROOM 4364-D",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333282018",
            "telephone_number": "954-262-4343",
            "fax_number": "954-262-1172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3301 COLLEGE AVE",
            "address_2": "UNIVERSITY CENTER ROOM 1433",
            "city": "FT. LAUDERDALE",
            "state": "FL",
            "postal_code": "333147721",
            "telephone_number": "954-262-5590",
            "fax_number": "954-262-5570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVA SOUTHEASTERN UNIVERSITY, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NOVA SOUTHEASTERN UNIVERSITY, INC.",
        "enumeration_date": "2007-02-02",
        "last_updated": "2023-05-24",
        "certification_date": "2023-05-24",
        "status": "A",
        "authorized_official_last_name": "ESTEVEZ",
        "authorized_official_first_name": "ROSEMERY",
        "authorized_official_title_or_position": "DIR OF CONTRACTING AND CREDEN",
        "authorized_official_telephone_number": "954-262-4343"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "98673",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Lauderdale, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.