JOHANNES V. BLOM, MD, PA (NPI# 1558505149) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558505149 |
| Entity Type | Organization |
| Organization Name | JOHANNES V. BLOM, MD, PA |
| Practice Address |
3702 Washington St Suite 202 Hollywood FL 33021-8282 |
| Practice Telephone | 9549646114 |
| Practice Fax Number | 9549621994 |
| Mailing Telephone | 9549646114 |
| Mailing Fax Number | 9549621994 |
| Enumeration Date | 2009-04-27 |
| Last Update Date | 2009-12-15 |
| Authorized Official Name | JOHANNES V. BLOM (PRESIDENT) |
| Authorized Official Telephone | 9549646114 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | ME94285 | FL | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | PROVIDER NPI | 1184654519 | 01 |
| FL | 275038400 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932410008 | Johannes V. Blom, Md, Pa | Orthopaedic Surgery | 300 Se 17th St, 2nd Floor, Ft Lauderdale, FL 33316-2550 | 2010-06-23 |
| 1457584468 | Johannes V. Blom, Md, Pa | Orthopaedic Surgery | 601 N Flamingo Rd, Suite 101, Pembroke Pines, FL 33028-1015 | 2009-08-25 |
| Street Address |
3702 WASHINGTON ST SUITE 202 |
| City | HOLLYWOOD |
| State | FL |
| Zip Code | 33021-8282 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740263441 | David A Krant | Orthopaedic Surgery | 3702 Washington St, Ste 101, Hollywood, FL 33021-8282 | 2005-11-28 |
| 1821540113 | Freddy Laguerre | Nurse Practitioner | 3702 Washington St, Hollywood, FL 33021-8282 | 2016-11-02 |
| 1134516974 | Cardiac & Veinworx LLC | Internal Medicine | 3702 Washington St, Suite 305, Hollywood, FL 33021-8282 | 2015-04-20 |
| 1932446655 | Central Palm Beach Physicians & Urgent Care Inc | Chiropractor | 3702 Washington St, Suite 202, Hollywood, FL 33021-8282 | 2013-01-15 |
| 1578868378 | Mayline Cordova | Physician Assistant | 3702 Washington St, Suite 303, Hollywood, FL 33021-8282 | 2011-01-26 |
| 1932438769 | Angelina V Cole | Physician Assistant | 3702 Washington St, Suite 303, Hollywood, FL 33021-8282 | 2009-12-07 |
| 1376775908 | Jason Sanders Md Pl LLC | Orthopaedic Surgery | 3702 Washington St, Suite 404, Hollywood, FL 33021-8282 | 2009-08-15 |
| 1437390382 | Eric S Rosen | Internal Medicine | 3702 Washington St, Suite 303, Hollywood, FL 33021-8287 | 2009-03-23 |
| 1518153840 | Troy Erik Elmstrom | Physician Assistant | 3702 Washington St, Suite 403, Hollywood, FL 33021-8282 | 2007-09-20 |
| 1194920298 | Neldes R Marranzini | Internal Medicine | 3702 Washington St, Suite 205, Hollywood, FL 33021-8283 | 2007-06-19 |
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|---|---|---|---|---|
| 1548893894 | Seminole Tribe of Florida Health Department | Pharmacy | 111 W. Coral Way, Hollywood, FL 33021 | 2020-02-14 |
| 1437714086 | Emilia Roxana Gucciardo | Physician Assistant | 4510 Sheridan Street, Attn: William Pepe, Hollywood, FL 33021 | 2019-05-08 |
| 1649763673 | Sabrina Shoba Mathura | Behavior Technician | 4400 Madison St, Hollywood, FL 33021 | 2018-06-13 |
| 1558850149 | South Broward Hospital District | Pediatrics | 105 Joe Dimaggio Dr, Pediatric Heart Station, Hollywood, FL 33021 | 2018-05-09 |
| 1942798368 | Kyndra Monique Liburd | Student in an Organized Health Care Education/Training Program | Attn: Pediatric Residency Program, 1005 Joe Dimaggio Drive, Hollywood, FL 33021 | 2018-05-01 |
| 1992292106 | Madeleine Mariela Reyes | Nurse Practitioner | 5010 Hollywood Boulevard #100-b, Hollywood, FL 33021 | 2018-04-13 |
| 1487168233 | Gynecologic Oncology & Urogynecology | Obstetrics & Gynecology | 1150 N 35th Ave Ste 670, Hollywood, FL 33021 | 2017-11-30 |
| 1245743012 | Healix Healthcare Services, LLC | Obstetrics & Gynecology | 3990 Sheridan St Ste 207, Hollywood, FL 33021 | 2017-11-14 |
| 1093233587 | Benjamin Laborde | Physical Therapy Assistant | 4200 Washington Street, Hollywood, FL 33021 | 2017-09-05 |
| 1477079358 | Tt Trans, LLC | Non-emergency Medical Transport (VAN) | 3550 Washington Street, 502, Hollywood, FL 33021 | 2017-08-22 |
| Find all providers in zip 33021 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
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| 1306114285 | Regional Imaging Inc | Specialist | 10786 Charleston Pl, Hollywood, FL 33026-4906 | 2011-12-07 |
| 1720376734 | Early Stages for Early Ages Inc. | Specialist | 203 Sw 85th Terr. Apt. 306, Hollywood, FL 33025 | 2011-07-12 |
| 1184936502 | Adelheid C. Reinoso Md, Pa | Specialist | 3700 Washinton Street, Suite 202, Hollywood, FL 33021-8249 | 2010-07-14 |
| 1922327832 | Andrea Hamilton | Specialist | 7986 Highway 162, Hollywood, SC 29449-5607 | 2010-05-18 |
| 1043538853 | Rosa Guzman | Specialist | 3837 Hollywood Blvd Ste B, Hollywood, FL 33021-1243 | 2010-05-04 |
| 1053577403 | Diane Elizabeth Reynolds | Specialist | 1714 Taft St, Hollywood, FL 33020-2836 | 2008-08-05 |
| 1306019823 | Lorena Lewy-altebaum, Md | Specialist | 3700 Washington St Ste 400, Hollywood, FL 33021-8289 | 2008-04-04 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.