Individual provider Active NPI

Andre Halabu, MD

  • Family Medicine Physician
  • Brandon, FL
National Provider Identifier
1902487119
Registry record updated Aug 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME168718 Issued in FL
Practice address
1721 Brandon Main St Ste a
Brandon, FL 33511-5018
Phone
(813) 315-1530
NPI assigned
Apr 19, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 4301509566 MI
Student in an Organized Health Care Education/Training Program 390200000X MI
Family Medicine Physician 207Q00000X ME168718 FL Primary

Addresses

Primary practice location

1721 Brandon Main St Ste a
Brandon, FL 33511-5018

Mailing address

38135 Market Square Dr
Zephyrhills, FL 33542-7505
Phone (352) 567-0188

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address fplakewood@flmed.directbygreenway.com Health Information Exchange (HIE)

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
I20240827003625 FL Practitioner - Family Practice 7810367166 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ohi West Medical Group II LLCGroup PAC ID 0648631192, 407 clinicians

Practice addresses (Care Compare)

1721 Brandon Main St
Suite a
Brandon, FL 33511-5018
Phone (813) 315-1530

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME168718FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ohi West Medical Group II LLC General Practice CurrentSince Sep 1, 2024 Accepting new patients
Ohi West Medical Group II LLC General Practice CurrentSince Sep 1, 2024 Accepting new patients

Locations

1721 Brandon Main St
Ste A
Brandon, FL 33511
Phone (813) 315-1530

38135 Market Square Dr
Zephyrhills, FL 33542
Phone (352) 567-0188

38135 Market Square Dr
Ste 101
Zephyrhills, FL 33542
Phone (813) 788-7651

Organizations & group practices 2

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": "1618790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722470400000",
    "number": "1902487119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38135 MARKET SQUARE DR",
            "city": "ZEPHYRHILLS",
            "state": "FL",
            "postal_code": "335427505",
            "telephone_number": "352-567-0188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1721 BRANDON MAIN ST STE A",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115018",
            "telephone_number": "813-315-1530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALABU",
        "first_name": "ANDRE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-19",
        "last_updated": "2024-08-01",
        "certification_date": "2024-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MI",
            "license": "4301509566",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME168718",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "fplakewood@flmed.directbygreenway.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "1721 Brandon Main St Ste A",
            "city": "Brandon",
            "state": "FL",
            "country_code": "US",
            "postal_code": "335115018",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Brandon, FL

Sources for this page

Verify at the official NPI Registry.