NPIMap

Individual provider Active NPI

Joseph Haider, D.O.

  • Family Medicine Physician
  • Bradenton, FL
National Provider Identifier
1962943746
Registry record updated Jul 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS16845 Issued in FL
Practice address
5123 4TH Avenue Cir E
Bradenton, FL 34208-5620
Phone
(941) 744-5510
NPI assigned
Mar 14, 2017
Last updated
Jul 9, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS16845 FL Primary
Student in an Organized Health Care Education/Training Program 390200000X FL

Addresses

Primary practice location

5123 4TH Avenue Cir E
Bradenton, FL 34208-5620

Mailing address

5123 4TH Avenue Cir E
Bradenton, FL 34208-5620
Phone (720) 630-0984

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200716003625 FL Practitioner - Family Practice 2668896101 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Legacy Healthcare Services IncGroup PAC ID 2163339722, shared by 46 NPIs, 3,431 clinicians
Cooper Family Medical PLLCGroup PAC ID 9931171782, 19 clinicians
H2 Rehabilitation Services of Florida LLCGroup PAC ID 3971411851, shared by 10 NPIs, 257 clinicians

Practice addresses (Care Compare)

17470 Brookside Trace CT
Tampa, FL 33647-6201
Phone (813) 443-5042

5123 4TH Ave Cir E
Bradenton, FL 34208-5620
Phone (941) 744-5510

8220 Natures Way
Apt 201
Lakewood Ranch, FL 34202-4208
Phone (800) 699-9395

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS16845FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cooper Family Medical PLLC Family Medicine CurrentSince Aug 1, 2020 Accepting new patients
CCRC Opco - Bradenton, LLC Past Accepting new patients

Locations

5123 4th Avenue Cir E
Bradenton, FL 34208
Phone (941) 744-5510

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/26999/brand/2/csg/1/fhir/r4

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
The Inn at Freedom VillageBradenton, FL, CCN 105655 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 1, 2025
Apr 10, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1489449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594252800000",
    "number": "1962943746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5123 4TH AVENUE CIR E",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342085620",
            "telephone_number": "720-630-0984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5123 4TH AVENUE CIR E",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342085620",
            "telephone_number": "941-744-5510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAIDER",
        "first_name": "JOSEPH",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-14",
        "last_updated": "2020-07-09",
        "certification_date": "2020-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS16845",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "FL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bradenton, FL

Sources for this page

Verify at the official NPI Registry.