Active NPI
Jordan Mussary, MD
- Pediatrics Physician
- Boca Raton, FL
National Provider Identifier
1962484477
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- ME66777
- Practice address
- 9801 Glades Rd
Boca Raton, FL 33434-3918 - Phone
- (561) 487-9912
- Fax
- (561) 487-5070
- NPI assigned
- Nov 18, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | ME66777 | FL | Primary |
Addresses
Primary practice location
9801 Glades Rd
Boca Raton, FL 33434-3918
Mailing address
9750 NW 33Rd St
Suite 101
Coral Springs, FL 33065-4042
Phone (954) 752-9220
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 379352400 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME66777 | FL | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vitalmd Group Holding LLC | Pediatrics | Past | Accepting new patients |
| Emergency Physician Enterprises | Past | Accepting new patients |
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.
-
- Emergency Medicine Physician
- Loxahatchee, FL
- NPI 1871588897
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132272000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320364800000",
"number": "1962484477",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9750 NW 33RD ST",
"address_2": "SUITE 101",
"city": "CORAL SPRINGS",
"state": "FL",
"postal_code": "330654042",
"telephone_number": "954-752-9220",
"fax_number": "954-755-5025"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9801 GLADES RD",
"city": "BOCA RATON",
"state": "FL",
"postal_code": "334343918",
"telephone_number": "561-487-9912",
"fax_number": "561-487-5070"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUSSARY",
"first_name": "JORDAN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-18",
"last_updated": "2011-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "FL",
"license": "ME66777",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "379352400",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boca Raton, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.