SPORTS MEDICINE ASSOCIATES OF SOUTH FLORIDA, P.A.

Provider Demographics

• NPI: 1487624771
• Name: SPORTS MEDICINE ASSOCIATES OF SOUTH FLORIDA, P.A.
• Entity type: Organization
• Organization Name: SPORTS MEDICINE ASSOCIATES OF SOUTH FLORIDA, P.A.
• Authorized Official - Title/Position: CREDENTIALING COORDINATOR
• Authorized Official - First Name: CHRYSTAL
• Authorized Official - Middle Name: A
• Authorized Official - Last Name: HERRERA
• Authorized Official - Phone: 305-218-6965
• Mailing Address - Street 1: 220 SW 84TH AVE STE 102
• Mailing Address - City: PLANTATION
• Mailing Address - State: FL
• Mailing Address - Zip Code: 33324-2729
• Mailing Address - Country: US
• Mailing Address - Phone: 954-349-2345
• Mailing Address - Fax: 954-641-1086
• Practice Address - Street 1: 220 SW 84TH AVE STE 102
• Practice Address - City: PLANTATION
• Practice Address - State: FL
• Practice Address - Zip Code: 33324-2729
• Practice Address - Country: US
• Practice Address - Phone: 954-720-1530
• Practice Address - Fax: 954-720-6540
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-01-26
• Last Update Date: 2024-09-24

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207X00000X	Allopathic & Osteopathic Physicians	Orthopaedic Surgery		Group - Multi-Specialty
No	207XS0106X	Allopathic & Osteopathic Physicians	Orthopaedic Surgery	Hand Surgery	Group - Multi-Specialty
No	207XX0005X	Allopathic & Osteopathic Physicians	Orthopaedic Surgery	Sports Medicine	Group - Multi-Specialty
No	208100000X	Allopathic & Osteopathic Physicians	Physical Medicine & Rehabilitation		Group - Multi-Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
FL	108857600	Other	MEDICAID - SYDNEE R. BRIN, PA-C
FL	002603000	Other	MEDICAID - PAUL R. BUCHANAN, PA-C
FL	1558022426	Other	MEDICAID - HANNA E. HEMMATI, PA-C
FL	002398700	Other	MEDICAID - ALEXANDER J. BERTOT, M.D.
FL	002876700	Medicaid
FL	002602400	Other	MEDICAID - ERIC D. BRONSON, PA-C
FL	002462700	Other	MEDICAID - DAVID SHENASSA, M.D.
FL	118651300	Other	MEDICAID - JESSE T. CROSNO, PA-C
FL	002615000	Other	MEDICAID - ALFRED A. DESIMONE, M.D.
FL	119205700	Other	MEDICAID - PEDRO A. RICART HOFFIZ, M.D.
FL	ET212X	Other	MEDICARE ID - KAY-ANN L. MULLINGS, PA-C
FL	JC559Z	Other	MEDICARE ID - FRANZ S. JONES, D.O.
FL	H14009	Other	MEDICARE UPIN - FERNANDO A MOYA, MD
FL	IK262Z	Other	MEDICARE ID - SYDNEE R. BRIN, PA-C
FL	002603000	Other	MEDICAID - PAUL R. BUCHANAN, PA-C
FL	002876700	Medicaid
FL	29261Z	Other	MEDICARE ID - ALEXANDER J BERTOT, MD
FL	U1464Z	Other	MEDICARE ID - ERIC BRONSON, PA-C
FL	002398700	Other	MEDICAID - ALEXANDER J. BERTOT, M.D.
FL	IZ043Z	Other	MEDICARE ID - REBECCA I. URRUTIA, PA-C
FL	002462700	Other	MEDICAID - DAVID SHENASSA, M.D.
FL	002602400	Other	MEDICAID - ERIC D. BRONSON, PA-C
FL	002615000	Other	MEDICAID - ALFRED A. DESIMONE, M.D.
FL	020871700	Other	MEDICAID - REBECCA I. URRUTIA, PA-C
FL	DC9475	Other	RR MEDICARE - GROUP
	DD524Z	Other	MEDICARE - DAVID SHENASSA, M.D.
FL	002422800	Other	MEDICAID - MARK S. FISHMAN, D.O.
FL	002615000	Other	MEDICAID - ALFRED A. DESIMONE, M.D.
FL	003103100	Other	MEDICAID - STEPHANIE R. SAPP, PA-C
	AD483Z	Other	MEDICARE ID - SARAH M. CALVEY, PA-C
FL	002876700	Medicaid