Individual provider Active NPI

Daniela Bou Daher Rachwan

  • Internal Medicine Physician
  • Fort Lauderdale, FL
National Provider Identifier
1912573148
Registry record updated Jul 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME168046 Issued in FL
Practice address
1600 S Andrews Ave
Fort Lauderdale, FL 33316-2510
Phone
(954) 355-4400
NPI assigned
May 28, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X ME168046 FL Primary

Addresses

Primary practice location

1600 S Andrews Ave
Fort Lauderdale, FL 33316-2510

Mailing address

201 E Sample Rd
Deerfield Beach, FL 33064-3502
Phone (954) 876-2790

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
I20240729002829 FL Practitioner - Internal Medicine 2961948732 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eastside Hospitalists IncGroup PAC ID 9436157831, 179 clinicians

Practice addresses (Care Compare)

3501 Johnson St
Hollywood, FL 33021-5421
Phone (954) 265-2000

Hospital & facility affiliations

  • Memorial Hospital West Hospital, Pembroke Pines, FL, CCN 100281

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME168046FLMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Eastside Hospitalists Inc CurrentSince Sep 1, 2024 Accepting new patients

Locations

3501 Johnson St
Pembroke Park, FL 33021
Phone (954) 265-2000

Organizations & group practices 1

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.

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": "1622160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721174400000",
    "number": "1912573148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 E SAMPLE RD",
            "city": "DEERFIELD BEACH",
            "state": "FL",
            "postal_code": "330643502",
            "telephone_number": "954-876-2790"
        },
        {
            "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": "954-355-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOU DAHER RACHWAN",
        "first_name": "DANIELA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-28",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME168046",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Lauderdale, FL

Sources for this page

Verify at the official NPI Registry.