NPIMap

Organization Active NPI

Nova Southeastern University, Inc

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Davie, FL
National Provider Identifier
1770722282
Registry record updated May 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Comprehensive Outpatient Rehabilitation Facility (CORF)Taxonomy code 261QR0401X
Legal business name
NOVA SOUTHEASTERN UNIVERSITY, INC
Practice address
3301 College Ave
Room 1441 - University Center
Davie, FL 33314
Phone
(954) 262-4100
Fax
(954) 262-1788
NPI assigned
Feb 9, 2009
Organization subpart
Yes
Parent organization
NOVA SOUTHEASTERN UNIVERSITY, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 17, 2018

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

Authorized official

Name
Dr. Robert S Oller, D.O.
Title
Ceo/Clinical Ooperations
Phone
(954) 262-4343

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X
Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X Primary

Addresses

Primary practice location

3301 College Ave
Room 1441 - University Center
Davie, FL 33314

Mailing address

PO Box 290250
Davie, FL 33329-0250
Phone (954) 262-4100

Other identifiers 1

IdentifierTypeStateIssuer
886463200MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

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
O20200722001919 FL Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 4486568896 1 other NPI on this enrollment
Practice locations: Davie, FL

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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
Part of
Nova Southeaster Univ

Locations

7600 SW 36th St
Rm 1263
Davie, FL 33328

3301 College Ave
Davie, FL 33314
Phone (800) 541-6682

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1234137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526515200000",
    "number": "1770722282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 290250",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333290250",
            "telephone_number": "954-262-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3301 COLLEGE AVE",
            "address_2": "ROOM 1441 - UNIVERSITY CENTER",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "33314",
            "telephone_number": "954-262-4100",
            "fax_number": "954-262-1788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVA SOUTHEASTERN UNIVERSITY, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NOVA SOUTHEASTERN UNIVERSITY, INC",
        "enumeration_date": "2009-02-09",
        "last_updated": "2018-05-17",
        "status": "A",
        "authorized_official_last_name": "OLLER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO/CLINICAL OOPERATIONS",
        "authorized_official_telephone_number": "954-262-4343",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "886463200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Davie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2018; 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.