Roman Yusupov, MD

Primary specialty

Clinical Genetics (M.D.) PhysicianTaxonomy code 207SG0201X

License

ME 107047 Issued in FL

Practice address

1131 N 35TH Ave FL 2
Hollywood, FL 33021-5403

Phone

(954) 265-6319

Fax

(954) 276-0166

NPI assigned

Jul 20, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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

Specialty

Pediatric Medicine

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

South Broward Hospital DistrictGroup PAC ID 8123927373, 659 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ryusupov9531@mhsdirect.net

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.

• South Broward Hospital District

  • Pediatric Nephrology Physician
  • Hollywood, FL
  • NPI 1467468496
  Medicare reassignment Care Compare group NPD
• South Broward Hospital District

  • Home Infusion Therapy Pharmacy
  • Miramar, FL
  • NPI 1043656614
  NPD
• South Broward Hospital District

  • Pulmonary Disease Physician
  • Hollywood, FL
  • NPI 1356359798

  Clinical Genetics (M.D.)

  NPD
• South Broward Hospital District

  • Durable Medical Equipment & Medical Supplies
  • Pembroke Pines, FL
  • NPI 1225284292
  NPD (past)
• South Broward Hospital District

  • Pediatric Orthopaedic Surgery Physician
  • Hollywood, FL
  • NPI 1407865520
  NPD (past)

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

{
    "created_epoch": "1184889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615852800000",
    "number": "1972703676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 CORPORATE WAY",
            "address_2": "DOOR D",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330253925",
            "telephone_number": "954-276-5685",
            "fax_number": "954-985-7074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1131 N 35TH AVE FL 2",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330215403",
            "telephone_number": "954-265-6319",
            "fax_number": "954-276-0166"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3377 S State Rd 7",
            "address_2": "Suite 100",
            "address_purpose": "LOCATION",
            "city": "Wellington",
            "state": "FL",
            "postal_code": "33449",
            "country_code": "US",
            "telephone_number": "561-341-7000",
            "fax_number": "561-784-7098",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4651 Sheridan St Ste 150",
            "address_purpose": "LOCATION",
            "city": "Hollywood",
            "state": "FL",
            "postal_code": "330213443",
            "country_code": "US",
            "telephone_number": "954-265-6331",
            "fax_number": "954-893-6244",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "YUSUPOV",
        "first_name": "ROMAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-20",
        "last_updated": "2021-03-16",
        "certification_date": "2021-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207SG0201X",
            "taxonomy_group": "",
            "desc": "Medical Genetics, Clinical Genetics (M.D.)",
            "state": "FL",
            "license": "ME 107047",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "017236900",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ryusupov9531@MHSDIRECT.NET",
            "affiliation": "N",
            "endpointDescription": "MHS DSM",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1131 N 35th Ave Fl 2",
            "city": "Hollywood",
            "state": "FL",
            "country_code": "US",
            "postal_code": "330215403",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Nabila Youssef
• Roel Alexis Yrsola II
• Erika Yu, PA-C
• Yangyang Yu, M.D.
• Chance Milan Yurco, PHARMD, RPH
• Yvette Pereyra Ans
• Ignacio Alfonso Zabaleta, M.D.
• Ahva Yasna Zadeh
• Charice Renel Zaehringer, CRNA
• Christina Maria Zafiris, PHD

• Clinical Genetics (M.D.) Physician in Hollywood, FL
• Providers in Hollywood, FL by specialty
• Clinical Genetics (M.D.) Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.